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https://www.readbyqxmd.com/read/28803078/safety-and-effectiveness-of-palliative-drug-treatment-in-the-last-days-of-life-a-systematic-literature-review
#1
REVIEW
Kristian Jansen, Dagny Faksvåg Haugen, Lisa Pont, Sabine Ruths
CONTEXT: Dying patients commonly experience potentially distressing symptoms. Palliative care guidelines recommend opioids, anticholinergics, antipsychotics and benzodiazepines for symptom relief. OBJECTIVES: To systematically review the effectiveness and safety of palliative drug treatment in the last days of life of adult patients, focusing on the management of pain, dyspnea, anxiety, restlessness, and death rattle. METHODS: A systematic search of the literature published before December 2016 in PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Cochrane, ClinicalTrials...
August 9, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28803074/hospice-palliative-care-development-in-hungary
#2
Agnes Csikos, Csilla Busa, Katalin Muszbek
During the past 25 years many developmental steps have occurred in Hungary in palliative care. Further education and service development is needed to provide a quality palliative care for all the Hungarian people. Hungary has a universal health care system with a developed infrastructure. The first Hungarian hospice team started in 1991. At that time the concept of hospice care was unknown. Symptom control and psychosocial support for the dying patient was inadequate. The regulatory framework was based on the 1997 Health Care Act which was followed by significant palliative care legislation including documents on the legal requirements for palliative care (2004)...
August 9, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28801001/examining-the-effects-of-a-home-based-palliative-heart-failure-program-on-quality-of-life-symptom-burden-satisfaction-with-care-and-caregiver-burden-among-patients-with-end-stage-heart-failure
#3
Alina Yee Man Ng, Frances Kam Yuet Wong
CONTEXT: Provision of home-based palliative care for seriously ill patients is important, yet few home-based palliative care services specifically or exclusively focus on end-stage heart failure (ESHF) patients. OBJECTIVES: This study aimed to examine the effect of a home-based palliative heart failure (HPHF) program on quality of life (QOL), symptoms burden, functional status, patient satisfaction and caregiver burden among patients with ESHF. METHODS: A two-group randomized controlled trial in three hospitals...
August 8, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28795293/endoscopic-palliation-of-pancreatic-cancer
#4
REVIEW
Vishal B Gohil, Jason B Klapman
Pancreas cancer is a fourth-leading cause of cancer death in the USA and its incidence is rising as the population is aging. The majority of patients present at an advanced stage due to the silent nature of the disease and treatment have focused more on palliation than curative intent. Gastroenterologists have become integral in the multidisciplinary care of these patients with a focus on providing endoscopic palliation of pancreas cancer. The three most common areas that gastroenterologists palliate endoscopically are biliary obstruction, cancer-related pain, and gastric outlet obstruction...
August 9, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28783424/practice-patterns-attitudes-and-barriers-to-palliative-care-consultation-by-gynecologic-oncologists
#5
Alexandre Buckley de Meritens, Benjamin Margolis, Craig Blinderman, Holly G Prigerson, Paul K Maciejewski, Megan J Shen, June Y Hou, William M Burke, Jason D Wright, Ana I Tergas
PURPOSE: We sought to describe practice patterns, attitudes, and barriers to the integration of palliative care services by gynecologic oncologists. METHODS: Members of the Society of Gynecologic Oncology were electronically surveyed regarding their practice of incorporating palliative care services and to identify barriers for consultation. Descriptive statistics were used, and two-sample z-tests of proportions were performed to compare responses to related questions...
August 7, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28776066/-management-of-an-elderly-patient-in-the-emergency-room-at-the-end-of-life-a%C3%A2-medical-ethics-challenge
#6
G Michels, R Nies, S Ortmann, R Pfister, F Salomon
A 94-year-old patient with cardiogenic shock due to myocardial infarction was admitted via the emergency room. A coronary angiography and intensive care were requested. The need for care due to dementia was known. After case discussion in the interdisciplinary and multiprofessional treatment team, the decision for a palliative care concept in the form of symptom control was made in the emergency room, taking into account the patient's medical history, the current situation, and the presumed patient consent...
August 3, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28772092/a-pilot-trial-of-early-specialty-palliative-care-for-patients-with-advanced-pancreatic-cancer-challenges-encountered-and-lessons-learned
#7
Yael Schenker, Nathan Bahary, Rene Claxton, Julie Childers, Edward Chu, Dio Kavalieratos, Linda King, Barry Lembersky, Greer Tiver, Robert M Arnold
BACKGROUND: Patients with advanced pancreatic cancer suffer from high morbidity and mortality. Specialty palliative care may improve quality of life. OBJECTIVE: Assess the feasibility, acceptability, and perceived effectiveness of early specialty physician-led palliative care for patients with advanced pancreatic cancer and their caregivers. DESIGN: A mixed-methods pilot randomized controlled trial in which patient-caregiver pairs were randomized (2:1) to receive specialty palliative care, in addition to standard oncology care versus standard oncology care alone...
August 3, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28768680/improving-specialist-palliative-care-in-residential-care-for-older-people-a-checklist-to-guide-practice
#8
Liz Forbat, Michael Chapman, Clare Lovell, Wai-Man Liu, Nikki Johnston
OBJECTIVES: Palliative care needs rounds are triage meetings that have been introduced in residential care for older adults to help identify and prioritise care for people most at risk for unplanned dying with inadequately controlled symptoms. This study sought to generate an evidence-based checklist in order to support specialist palliative care clinicians integrate care in residential nursing homes for older people. METHODS: A grounded theory ethnographic study, involving non-participant observation and qualitative interviews...
August 2, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28760818/research-protocol-on-early-palliative-care-in-patients-with-acute-leukaemia-after-one-relapse
#9
Cécile Barbaret, Julien Berthiller, Anne-Marie Schott Pethelaz, Mauricette Michallet, Gilles Salles, Stéphane Sanchez, Marilène Filbet
OBJECTIVES: According to the American Society of Clinical Oncology palliative care referrals are made within the last 3 weeks of patients' lives and most frequently when oncological treatments have ceased especially for patients with haematological malignancies. Recent publications indicate that patients with acute leukaemia are prone to symptoms, an indication for which a close collaboration between the patient's haematologist and a palliative care team might result in improved symptom management...
July 31, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28740925/characterization-of-efficacy-and-toxicity-after-high-dose-pelvic-reirradiation-with-palliative-intent-for-genitourinary-second-malignant-neoplasms-or-local-recurrences-after-full-dose-radiation-therapy-in-the-pelvis-a-high-volume-cancer-center-experience
#10
Sophia C Kamran, Lauren C Harshman, Mandar S Bhagwat, Vinayak Muralidhar, Paul L Nguyen, Neil E Martin, Stephanie La Follette, Sarah Faso, Akila N Viswanathan, Jason A Efstathiou, Clair J Beard
PURPOSE: The use of large-field external beam reirradiation (re-RT) after pelvic radiation therapy (RT) for genitourinary (GU) cancers has not been reported. We report the results of such treatment in patients with either symptomatic GU second malignant neoplasms or locally recurrent pelvic tumors after initial RT for whom surgery or further systemic therapy was not an option. METHODS AND MATERIALS: The records of 28 consecutive patients with advanced, bulky GU malignancies treated with high-dose, large-field re-RT with palliative intent between 2008 and 2014 were retrospectively reviewed...
April 2017: Advances in Radiation Oncology
https://www.readbyqxmd.com/read/28720558/my-team-of-care-study-a-pilot-randomized-controlled-trial-of-a-web-based-communication-tool-for-collaborative-care-in-patients-with-advanced-cancer
#11
Teja Voruganti, Eva Grunfeld, Trevor Jamieson, Allison M Kurahashi, Bhadra Lokuge, Monika K Krzyzanowska, Muhammad Mamdani, Rahim Moineddin, Amna Husain
BACKGROUND: The management of patients with complex care needs requires the expertise of health care providers from multiple settings and specialties. As such, there is a need for cross-setting, cross-disciplinary solutions that address deficits in communication and continuity of care. We have developed a Web-based tool for clinical collaboration, called Loop, which assembles the patient and care team in a virtual space for the purpose of facilitating communication around care management...
July 18, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28718321/breathlessness-services-as-a-new-model-of-support-for-patients-with-respiratory-disease
#12
Claudia Bausewein, Michaela Schunk, Philipp Schumacher, Julika Dittmer, Anna Bolzani, Sara Booth
The complexity of breathlessness in advanced disease requires a diversity of measures ideally tailored to the individual patient needs. 'Breathlessness services' have been systematically developed and tested to provide specific interventions and support for patients and their carers. The aim of this article is (1) to identify and describe components of breathlessness services and (2) to describe the clinical model of one specific service in more detail. This article is based on a systematic review evaluating randomized controlled trials (RCTs) and quasi-RCTs which examine the effectiveness of services aiming to improve breathlessness of patients with advanced disease...
January 1, 2017: Chronic Respiratory Disease
https://www.readbyqxmd.com/read/28716797/a-pragmatic-phase-iii-multisite-double-blind-placebo-controlled-parallel-arm-dose-increment-randomised-trial-of-regular-low-dose-extended-release-morphine-for-chronic-breathlessness-breathlessness-exertion-and-morphine-sulfate-beams-study-protocol
#13
David Currow, Gareth John Watts, Miriam Johnson, Christine F McDonald, John O Miners, Andrew A Somogyi, Linda Denehy, Nicola McCaffrey, Danny J Eckert, Philip McCloud, Sandra Louw, Lawrence Lam, Aine Greene, Belinda Fazekas, Katherine C Clark, Kwun Fong, Meera R Agar, Rohit Joshi, Sharon Kilbreath, Diana Ferreira, Magnus Ekström
INTRODUCTION: Chronic breathlessness is highly prevalent and distressing to patients and families. No medication is registered for its symptomatic reduction. The strongest evidence is for regular, low-dose, extended- release (ER) oral morphine. A recent large phase III study suggests the subgroup most likely to benefit have chronic obstructive pulmonary disease (COPD) and modified Medical Research Council breathlessness scores of 3 or 4. This protocol is for an adequately powered, parallel-arm, placebo-controlled, multisite, factorial, block-randomised study evaluating regular ER morphine for chronic breathlessness in people with COPD...
July 17, 2017: BMJ Open
https://www.readbyqxmd.com/read/28711751/the-conversion-ratio-from-intravenous-hydromorphone-to-oral-opioids-in-cancer-patients
#14
Akhila Reddy, Marieberta Vidal, Saneese Stephen, Karen Baumgartner, Sara Dost, Ann Nguyen, Yvonne Heung, Simeon Kwan, Angelique Wong, Imelda Pangemanan, Ahsan Azhar, Supakarn Tayjasanant, Edenmae Rodriguez, Jessica Waletich, Kyu-Hyoung Lim, Jimin Wu, Diane Liu, Janet Williams, Sriram Yennurajalingam, Eduardo Bruera
BACKGROUND: The lack of knowledge of the accurate conversion ratio (CR) between intravenous (IV) and oral hydromorphone and opioid rotation ratio (ORR) between IV hydromorphone and oral morphine equivalent daily dose (MEDD) may lead to poorly controlled pain or overdosing in cancer inpatients. We aimed to determine the CR and ORR from IV hydromorphone to oral hydromorphone and MEDD (obtained from oral morphine and oxycodone). METHODS: 4745 consecutive inpatient palliative care consults during 2010-14 were reviewed for conversions from IV hydromorphone to oral hydromorphone, morphine or oxycodone...
July 12, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28708236/psychosocial-interventions-for-fatigue-during-cancer-treatment-with-palliative-intent
#15
REVIEW
Hanneke Poort, Marlies Peters, Gijs Bleijenberg, Marieke Fm Gielissen, Martine Margaretha Goedendorp, Paul Jacobsen, Stans Verhagen, Hans Knoop
BACKGROUND: Fatigue is a prevalent and burdensome symptom for patients with incurable cancer receiving cancer treatment with palliative intent and is associated with reduced quality of life. Psychosocial interventions seem promising for management of fatigue among cancer patients. OBJECTIVES: To assess the effects of psychosocial interventions for fatigue in adult patients with incurable cancer receiving cancer treatment with palliative intent. SEARCH METHODS: We searched the following databases: CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, and seven clinical trial registries; we also searched the reference lists of articles...
July 14, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28708043/reirradiation-spine-stereotactic-body-radiation-therapy-for-spinal-metastases-systematic-review
#16
Sten Myrehaug, Arjun Sahgal, Motohiro Hayashi, Marc Levivier, Lijun Ma, Roberto Martinez, Ian Paddick, Jean Régis, Samuel Ryu, Ben Slotman, Antonio De Salles
OBJECTIVE Spinal metastases that recur after conventional palliative radiotherapy have historically been difficult to manage due to concerns of spinal cord toxicity in the retreatment setting. Spine stereotactic body radiation therapy (SBRT), also known as stereotactic radiosurgery, is emerging as an effective and safe means of delivering ablative doses to these recurrent tumors. The authors performed a systematic review of the literature to determine the clinical efficacy and safety of spine SBRT specific to previously irradiated spinal metastases...
July 14, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28707846/palliative-sedation-ethical-aspects
#17
Guido Miccinesi, Augusto Caraceni, Marco Maltoni
Palliative sedation (PS), the medical act of decreasing a patient's awareness to relieve otherwise intractable suffering, is considered by some commentators to be controversial because of its consequences on residual survival and/or quality of life, and to be inappropriate for treating pure existential suffering. We will argue that PS must be always proportional, i.e. controlling refractory symptoms while keeping the loss of personal values (communication, affective relationships, care relationship) as low as possible, and that imminence of death is necessary too, from an ethical point of view, if a deep and continuous sedation (DCS) is proposed...
July 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28707168/acupuncture-for-cancer-related-fatigue-in-lung-cancer-patients-a-randomized-double-blind-placebo-controlled-pilot-trial
#18
Chien-Shan Cheng, Lian-Yu Chen, Zhou-Yu Ning, Chen-Yue Zhang, Hao Chen, Zhen Chen, Xiao-Yan Zhu, Jing Xie
BACKGROUND: Cancer-related fatigue (CRF) is a distressing symptom that is the most common unpleasant side effect experienced by lung cancer patients and is challenging for clinical care workers to manage. METHODS: We performed a randomized, double-blind, placebo-controlled pilot trial to evaluate the clinical effect of acupuncture on CRF in lung cancer patients. Twenty-eight patients presenting with CRF were randomly assigned to active acupuncture or placebo acupuncture groups to receive acupoint stimulation (LI-4, Ren-6, St-36, KI-3, and Sp-6) twice per week for 4 weeks, followed by 2 weeks of follow-up...
July 13, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28697317/management-of-malignant-bowel-obstruction-associated-with-gi-cancers
#19
Aaron J Franke, Atif Iqbal, Jason S Starr, Rajesh M Nair, Thomas J George
For many patients with GI malignancies, the seeding of the abdominal cavity with tumor cells, called peritoneal carcinomatosis, is a common mode of metastases and disease progression. Prognosis for patients with this aspect of their disease remains poor, with high disease-related morbidity and complications. Uniform and proven practices that provide optimal palliative care and quality of life for these patients are needed. The objective of this review is to critically assess the current literature regarding palliative strategies in the management of peritoneal carcinomatosis and associated symptoms in patients with advanced GI cancers...
July 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28696044/practice-patterns-of-palliative-radiation-therapy-in-pediatric-oncology-patients-in-an-international-pediatric-research-consortium
#20
Avani Dholakia Rao, Qinyu Chen, Ralph P Ermoian, Sara R Alcorn, Maria Luisa S Figueiredo, Michael J Chen, Karin Dieckmann, Shannon M MacDonald, Matthew M Ladra, Daria Kobyzeva, Alexey V Nechesnyuk, Kristina Nilsson, Eric C Ford, Brian A Winey, Rosangela C Villar, Stephanie A Terezakis
BACKGROUND/OBJECTIVES: The practice of palliative radiation therapy (RT) is based on extrapolation from adult literature. We evaluated patterns of pediatric palliative RT to describe regimens used to identify opportunity for future pediatric-specific clinical trials. DESIGN/METHODS: Six international institutions with pediatric expertise completed a 122-item survey evaluating patterns of palliative RT for patients ≤21 years old from 2010 to 2015. Two institutions use proton RT...
July 11, 2017: Pediatric Blood & Cancer
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