Articles: palliative-care.
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The theories of loss and grief described by Freud and Bowlby have provided considerable interest in anticipatory grief. Anticipatory grief is assumed to be akin to post-death grief, but commencing prior to the loss of the loved one. 'Grief work' completed during the anticipatory period is purported to mitigate against abnormal grief reactions after death and enhance adjustment to loss. Research conducted to investigate the link between anticipatory grief and postbereavement adjustment has not, however, yielded conclusive findings. ⋯ The physiological, psychological, interpersonal and sociocultural factors evident in the terminal situation serve to highlight the existence of many previously unconsidered variables which may determine the anticipatory grief experience. Until the influence of these determining variables is acknowledged and researchers learn to look beyond the parameters of the traditional models of grief, the costs and/or benefits of the anticipatory period will remain largely undefined. A good starting point may be the adoption of the alternative label, 'terminal response'.
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Important differences become evident in a comparison of cancer pain between children and adults. Management of pain in children is commonly multidisciplinary, is less dependent on invasive measures and relies more on systemic therapy. Children are not little adults: their immaturity, developing cognition and dependence all influence their experience and interpretation of pain. ⋯ We are opposed to euthanasia. Psychosocial and cultural issues all influence the family's experience of palliative care. Further research is necessary in all of these areas.(ABSTRACT TRUNCATED)
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Bone metastases that develop in patients with advanced prostate cancer often cause deep, unremitting pain. Palliative options for the control of this pain include analgesic support, cytotoxic chemotherapy and external-beam radiotherapy. In addition to external irradiation, interest in intravenously injected radioisotopes that are preferentially localized to bone has been mounting. ⋯ In the large, randomized Trans Canada study in which Metastron or placebo was given to patients as an adjunct to local field irradiation, those patients treated with Metastron had a significantly reduced intake of analgesics. Furthermore, progression of pain, as measured either by sites of new pain or by the requirement for further palliative radiotherapy, demonstrated statistically significant differences in favour of Metastron. There is thus increasing evidence of a useful role for Metastron in the treatment of prostate cancer metastatic to bone.