The cancer journal
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There is a compelling need to integrate spirituality into the provision of quality palliative care by oncology professionals. Patients and families report the importance of spiritual, existential, and religious concerns throughout the cancer trajectory. Leading palliative care organizations have developed guidelines that define spiritual care and offer recommendations to guide the delivery of spiritual services. ⋯ Attention to person-centered, family-focused oncology care requires the development of a health care environment that is prepared to support the religious, spiritual, and cultural practices preferred by patients and their families. These existential concerns become especially critical at end of life and following the death for family survivors. Oncology professionals require education to prepare them to appropriately screen, assess, refer, and/or intervene for spiritual distress.
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Advances in medical care and increasing prevalence of noncommunicable illnesses such as cardiovascular disease and cancer had raised concerns about respecting the patients' dying wishes as early as 1938, when the Euthanasia Society of America was formed. Many high-profile cases and landmark court decisions later, there are now several ways in which different states regulate the patients' end-of-life wishes. How these laws evolved, how seminal cases and medical and ethical advances helped shape the current state of end-of-life legislation, and how patients-especially those with cancer-began adopting various forms of advance directives will be the topic of this article.
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Review
Integrating palliative care in oncology: the oncologist as a primary palliative care provider.
The provision of comprehensive cancer care in an increasingly complex landscape necessitates that oncology providers familiarize themselves with the application of palliative care. Palliative care is a learnable skill. ⋯ The basic tenets of providing palliative care emphasize: frequent and honest communication, routine and systematic symptom assessment, integration of spiritual assessments, and early integration of specialized hospice and palliative care resources as a patient's circumstances evolve. This article will endeavor to review and synthesize recent developments in the palliative care literature, specifically as they pertain to the oncologist as a primary palliative care provider.
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Recent advances in medical science have prolonged the life expectancy for many cancer patients. However, many studies demonstrate that cancer pain is a symptom for two thirds of patients in the advanced stages of the disease and nearly universal in the last 48 hours of life. Whereas most cancer patients can be effectively treated with conventional analgesics, 10% to 15% of patients require additional, and sometimes invasive, therapy. ⋯ Neurolytic blocks, such as celiac plexus and ganglion of impar block, are still used in the management of pain related to abdominal and pelvic cancers. Nondestructive interventional techniques include the use of epidural and intrathecal spinal analgesics. The efficacy, recommended medications, and adverse effect profile of these therapies are reviewed.
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The objective of this study was to evaluate the palliative treatment benefit of surface-mold computer-optimized high-dose-rate brachytherapy (SMBT) for in-transit cutaneous metastases of Merkel cell carcinoma (MCC). ⋯ Surface-mold computer-optimized high-dose-rate brachytherapy offers effective and durable palliation for cutaneous metastases of MCC, although it does not appear to alter disease course.