Prevalence of Symptoms in Older Cancer Patients Receiving Palliative Care: A Systematic Review and Meta-Analysis

ContextSymptom control is an essential part of palliative care and important to achieve optimal quality of life. Studies showed that patients with all types of advanced cancer suffer from diverse and often severe symptoms. Research focusing on older persons is scarce because this group is often excluded from studies. Consequently, it is unclear which symptoms older palliative care patients with cancer experience and what is the prevalence of these symptoms. To date, no systematic review has been performed on the prevalence of symptoms in older cancer patients receiving palliative care.ObjectivesThe objective of this systematic review was to search and synthesize the prevalence figures of symptoms in older palliative care patients with cancer.MethodsA systematic search through multiple databases and other sources was conducted from 2002 until April 2012. The methodological quality was evaluated. All steps were performed by two independent reviewers. A meta-analysis was performed to pool the prevalence of symptoms.ResultsSeventeen studies were included in this systematic review. Thirty-two symptoms were identified. The prevalence of these symptoms ranged from 3.5% to 77.8%. The most prevalent symptoms were fatigue, excretory symptoms, urinary incontinence, asthenia, pain, constipation, and anxiety and occurred in at least 50% of patients.ConclusionThere is a high degree of uncertainty about the reported symptom prevalence because of small sample sizes, high heterogeneity among studies, and the extent of instrument validation. Research based on rigorous methods is needed to allow more conclusive results.     

Palliative Sedation for Existential Suffering: A Systematic Review of Argument-Based Ethics Literature

Context

Although unanimity exists on using palliative sedation (PS) for controlling refractory physical suffering in end-of-life situations, using it for controlling refractory existential suffering (PS-ES) is controversial. Complicating the debate is that definitions and terminology for existential suffering are unclear, ambiguous, and imprecise, leading to a lack of consensus for clinical practice.

The Role of Palliative Care in Burns: A Scoping Review

ContextPatients with severe burns may face distressing symptoms with a high risk of mortality as a result of their injury. The role of palliative care in burns management remains unclear.ObjectiveTo appraise the literature on the role of palliative care in burns management.MethodsWe used scoping review with searches in 12 databases from their inception to August 2019. The citation retrieval and retention are reported in a PRISMA statement.Findings39 papers comprising of 30 primary studies (26 from high-income and four from middle-income countries), four reviews, two editorials, two guidelines, and one expert board review document were retained in the review. Palliative care is used synonymously with comfort and end-of-life care in burns literature. Comfort care is mostly initiated when active treatment is withheld (early deaths) or withdrawn (late deaths), limiting its overall benefits to burn patients, their families, and health care professionals. Futility decisions are usually complex and challenging, particularly for patients in the late death category, and it is unclear if these decisions result in timely commencement of comfort care measures. Three comfort care pathways were identified, but it remained unclear how these pathways evaluated “good death” or supported the family which creates the need for the development of other evidence-based guidelines.ConclusionPalliative care is applicable in burns management, but its current role is mostly confined to the end-of-life period, suggesting that it is not been fully integrated in the management process. Evidence-based guidelines are needed to support the integration and delivery of palliative care in the burn patient population.     

Memory and Cancer: A Review of the Literature

The mental health of cancer survivors has not always been the primary emphasis of treatment protocols since physical health outcomes have taken precedence. Older cancer survivors experience a double jeopardy since they are at risk for memory impairments and mild cognitive impairment and because they are greater than 55 years of age. Of the 9.6 million cancer survivors in the US who have completed active treatment, many report cognitive difficulties, with labels such as "chemo brain," "not as sharp," "woolly-headedness," or the "mind does not work as quickly". To date, most of our knowledge of cognitive impairment in cancer survivors comes from female breast cancer survivors. Studies indicate that these survivors have diminished executive function, verbal memory, and motor function. Cancer survivors want to live independently in the community for as long as possible however, these cognitive deficits may prevent this desired lifestyle. To broaden our understanding this paper reviews the literature on the cognitive impairment and memory deficits experienced by three groups of cancer survivors breast, colorectal, and prostate cancer, that make up 60% of all survivors nationally. Even though mental health declined after a cancer diagnosis, the long-term outcomes of cancer survivors did not differ from persons without cancer in depression or cognitive function.     

Adverse Health Outcomes Associated with Postdiagnosis Smoking in Prostate Cancer Patients: A Literature Review

This literature review presents what is currently known about the association between postdiagnosis smoking and adverse health outcomes in prostate cancer. A literature search was conducted using Ovid Embase and Ovid MEDLINE. Information from 36 studies was summarized. There is strong evidence across the included studies of higher overall mortality and biochemical recurrence in current smokers diagnosed with prostate cancer. In addition, enhanced adverse effects following surgery, radiation, and hormone therapy have also been identified in current smokers of this population.     

癌症病人新的护理目标--希望

对于每位病人来说 ,希望都是一种内在主宰生活的力量 ;对于癌症病人来说 ,它可以显著地促进心理调节 ,甚至能够影响到病人的生存[1] 。病人如果不存在希望 ,即使采用最好的药物及医疗措施也不一定顺利。因此 ,护理人员帮助病人树立希望和信心十分重要。国外护理界已经将希望作为癌症病人的一个新的护理目标 ,但是国内尚未引起足够的重视。现就此问题展开讨论 ,以引起广大护理工作者的兴趣和关注。1　希望与希望理论1.1　希望的定义　希望 (hope)是一个对人类身心健康有着重要影响的课题 ,近几十年来一直受到国外心身医学领域的重视。Miller…     

Delivering Palliative Care to Hospitalized Oncology Patients: A Scoping Review

ContextEarly, longitudinal integration of palliative care (PC) is recommended for patients with advanced cancer, in both inpatient and outpatient settings. Despite the growth of specialty PC teams in the last decade, the majority of PC is still delivered in the inpatient setting using a traditional referral-based consult delivery model. However, traditional consultation can lead to significant variation or delay in inpatient PC utilization. New care delivery models and strategies are emerging to deliver PC to hospitalized oncology patients who would most benefit from their services and to better align with professional society recommendations.ObjectivesTo identify different care models to deliver PC to ho`spitalized oncology patients and summarize their impact on patient and health system-related outcomes.MethodsWe conducted a scoping review of peer-reviewed articles from 2006 to 2021 evaluating delivery of PC to oncology patients in acute inpatient care. We abstracted study characteristics, the study's intervention and comparison arms, and outcomes related to specialty PC intervention.ResultsWe identified four delivery models that have been reported to deliver PC: 1) traditional referral-based consultation, 2) criterion-based or “triggered” consultation, 3) co-rounding with primary inpatient team, and 4) PC clinicians serving as the primary team. We summarize the known outcomes data from each model, and compare the benefits and limitations of each model.ConclusionOur findings provide guidance to health systems about care delivery models to deploy and implement inpatient PC resources to best serve their unique populations.     

对国内外关于肿瘤并发焦虑患者认知研究文献的分析

目的分析国内外护理工作中有关肿瘤并发焦虑患者的认知研究状况。方法对中文数据库（CBM、万方数据库和中国期刊全文数据库）、PubMed数据库1998-2007年10年间关于肿瘤患者并发焦虑的认知研究护理文献检索并分析。结果符合纳入标准的文献，数量：中文数据库共计25篇，10年间文献数量有所增加（P＞0.05）；Pubmed数据库计19篇，10年间文献数量增加不明显（P＞0.05）。质量：CBM数据库中系统评价类文献0篇，队列研究性文献7篇，系列个案分析、描述性研究类文献14篇；Pubmed数据库中系统评价5篇，描述性研究、系列个案分析的文献有8篇。两数据库差异无统计学意义（P＞0.05）。研究领域：在两数据库检索的资料均涉及肿瘤患者并发焦虑护理理论、应用及调查分析等方面。结论有关肿瘤患者并发焦虑的认知研究在国内外已得到关注，但与国外部分国家相比，我国还存在很多不足，护理研究文献的质量有待提高，护理工作者对认知干预的认识存在偏差。     

A Systematic Review Examining the Literature on Attitudes of Patients with Advanced Cancer Toward Research

The attitudes of heterogeneous groups of cancer patients towards research have been studied extensively. Less is known about these attitudes in the advanced cancer population. Such patients may have differing attitudes for a variety of reasons, including burden of disease and social factors. This systematic review examines the literature on attitudes of patients with advanced cancer toward research and aims to define common themes. The following databases were searched electronically: CINAHL (1982–2007), the Cochrane Database of Systematic Reviews (2007), Embase (1996–2007), and Medline (1996–2007). Additionally, the following journals were hand searched: Palliative Medicine, Journal of Pain and Symptom Management, and the European Journal of Palliative Care. The search terminologies used were: “Cancer” AND “Attitudes” AND “Research” AND “Palliative Care.” All subheadings were included. Results were limited to English-language journals and studies involving humans. Of the 637 articles retrieved, 11 were included after an appraisal process. Both positive and negative attitudes toward research in advanced cancer were identified. Common themes of altruism, hope, and self-benefit were identified in 10 studies as a motivation for trial participation. Negative attitudes toward symptom control and risk of increased hospital admissions were identified in four studies. Most of the studies involved patients' views about participating in hypothetical trials, limiting the generalizability of results. An important step for future work would be to examine the experiences and opinions of patients with advanced cancer who have actually participated in a clinical trial.     

浅谈晚期癌症姑息治疗的几个原则

<正>目前,晚期癌症患者的姑息性治疗问题已日益引起医学界和社会各界的高度重视。尽管人类经过上百年的努力,试图彻底克服癌症这一顽症,但据有关资料报道,发达国家     

Understanding the Role of Allies in Systemic Consumer Empowerment: A Literature Review

Contemporary mental health policies call for the inclusion of consumers in the development, implementation and evaluation of mental health services. Barriers to systemic consumer engagement have been related to unequal distributions of power. One of the goals of the consumer movement is to address imbalances of power, resources and knowledge. Empowerment through consumer leadership in the mental health sector has been identified as a fundamental goal of the consumer movement and has been considered the philosophical basis for alternative models of mental health care. However, currently such systemic empowerment is poorly understood, assuming diverse and at times contradictory definitions within mental health literature. The role of allies as facilitators of systemic empowerment opportunities has been recognised and valued within numerous social movements. Currently, there is a lack of research in regards to the potential role of allies in the consumer movement and more specifically in systemic consumer empowerment. Future research should seek to more clearly define systemic consumer empowerment. Additionally, future research collaborations between consumer and ally perspectives should specifically investigate the role of allies in systemic consumer empowerment, to highlight potential opportunities and limitations.     

癌症领域智能手机应用程序构建方法的系统评价

目的 系统评价癌症领域智能手机应用程序构建方法,进一步规范癌症领域手机应用程序的构建。方法 计算机检索多个数据库,时间限定为建库至2019年12月。纳入癌症领域智能手机应用程序的构建研究,进行描述性分析。结果 共纳入13个研究,癌症领域智能手机APP构建的总体步骤是以科研人员为核心,以癌症患者需求为导向,明确APP功能定位后,研究人员与医护专业人员、专家和技术开发人员紧密配合设计研发并进行检验的过程。结论 癌症领域智能手机APP构建方法的严谨性直接影响干预效果及研究结论的真实与准确性,研究者需重视APP的构建过程,组织多学科团队,采用严谨的构建方法,形成高质量的APP,以期更好地满足癌症患者的需求。     

Palliative Sedation in Patients With Advanced Cancer Followed at Home: A Prospective Study

ContextHome care programs in Italy.ObjectivesThe aim of this study was to assess a protocol for palliative sedation (PS) performed at home.MethodsA total of 219 patients were prospectively assessed to evaluate a PS protocol in patients with advanced cancer followed at home by two home care programs with different territorial facilities. The protocol was based on stepwise administration of midazolam.ResultsA total of 176 of the patients died at home, and PS was performed in 24 of these patients (13.6%). Younger patients received the procedure more frequently than older patients (P = 0.012). The principal reasons to start PS were agitated delirium (n = 20) and dyspnea (n = 4). Mean duration of PS was 42.2 ± 30.4 hours, and the mean doses of midazolam were 23–58 mg/day. Both the home care team and the patients' relatives expressed optimal or good levels of satisfaction with the procedure in all but one case, respectively.ConclusionThis protocol for PS was feasible and effective in minimizing distress for a subgroup of patients who died at home. The characteristics of patients who may be effectively sedated at home should be better explored in future studies.     

Distress Among Locally Advanced Breast Cancer Patients from Diagnosis to Follow-Up: A Critical Review of Literature

ObjectiveThis critical review used a systematic approach to explore the prevalence of distress among locally advanced breast cancer (LABC) patients along their treatment journey. This review explored the domains of distress (psychosocial, physical and/or practical) that are significant to this patient population and determined indications for psychosocial support throughout the patients' treatment.MethodsElectronic databases including CINAHL, EmBase, Medline PsycInfo, and gray literature were searched from the year 2000 to 2016, to produce relevant literature. A critical review was conducted on 73 articles meeting the inclusion and exclusion criteria. A narrative synopsis was used to summarize the findings under key themes.ResultsThe results indicate that 16/73 studies assessed for distress in all three domains of distress throughout the treatment course. A meta-analysis was not possible due to the methodological heterogeneity of the articles, the variation of assessment tools used, timing in which the assessments were done, and the different treatment modalities. Distress was prevalent from the time of diagnosis, through treatment, and into survivorship. Sexuality, body image, age, financial difficulty, family/social support, and informational needs were common themes that emerged among the LABC population in these studies.ConclusionsComprehensive assessments incorporating all three domains of distress with the appropriate tools will assist health care professionals throughout the complicated treatment trajectory of LABC patients in taking a more proactive approach in assisting patients' concerns and preventing undue or increase in psychological distress during or after active treatment. This will encourage effective patient-centered communication and supportive care referrals for a better patient experience.