Articles: palliative-care.
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Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1990
[Monitoring and management of the central nervous system in treatment of tumor cachexia].
After palliative surgery artificial nutrition is indicated primarily in patients receiving postoperative chemotherapy or radiotherapy. The techniques of ambulatory enteral or parenteral nutrition have been standardized during the past decade. ⋯ An improvement of the nutritional status can be expected in most of the patients. Further clinical trials are needed to determine whether the patients' quality of life improves.
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The lack of control of physical suffering among cancer patients in the last days or hours of life is a common medical problem but it is rarely discussed in an open fashion. We carried out a prospective study of the dying of 120 terminal cancer patients assisted by a home care team. We documented how long it was before death that physical symptoms, unendurable to the patient and controlled only by sedation-inducing sleep, appeared. ⋯ The most frequent symptoms were dyspnea in lung and head and neck disease; pain in breast, gastrointestinal tract, colon-rectum, and male genitourinary tract cancer; and vomiting in female genitourinary tract malignancies. Data reported emphasize the clinical relevance of physical symptoms in the last days of life in terminal cancer patients and how these serve to indicate imminent death. More than 50% of these patients die with physical suffering that is controllable only by means of sedation.
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The growth of various palliative care programs is continuing. The family unit is affected by the need for palliative care in one family member. It is critical, therefore, to know what models of palliative care are preferred by families who are experiencing the need for such services. ⋯ Five interrelated concepts explained this preference. The ability of families to realize their preference was dependent upon four factors. These concepts and factors are discussed, focusing on resultant implications for practice.
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The change of target variables in palliative cancer treatment led to a new evaluation of quality of life. Its use as a target variable to discriminate different therapies is problematic. Investigations with a patient-questionnaire assessing quality of life showed that the validity of this term is difficult to judge. At present it should be used in clinical research as an accompanying variable only.