共查询到20条相似文献,搜索用时 15 毫秒
1.
Kazuki Sato Mitsunori Miyashita Tatsuya Morita Makiko Sanjo Yasuo Shima Yosuke Uchitomi 《Supportive care in cancer》2008,16(2):113-122
Goals In Japan, most cancer patients die in the hospital. The aim of this study was to assess the quality of end-of-life treatment
for dying cancer patients in general wards and palliative care unit (PCU).
Materials and methods A retrospective chart review study was conducted. The following data on cancer patients who died in general wards (N = 104) and PCU (N = 201) at a regional cancer center were collected: do-not-resuscitate (DNR) decisions, treatments in the last 48 h of life,
and aggressiveness of cancer care for dying patients.
Main results DNR orders were documented for most patients (94% in general wards, 98% in PCU, p = 0.067) and families usually consented (97%, 97%, p = 0.307). Comparison of general wards with PCU showed that, in the last 48 h of life, significantly more patients in general
wards received life-sustaining treatment (resuscitation, 3.8%, 0%, p = 0.001; mechanical ventilation, 4.8%, 0%, p = 0.004), large volume hydration (>1,000 ml/day, 67%, 10%, p < 0.001) with continuous administration (83%, 5%, p = 0.002) and fewer palliative care drugs (strong opioids, 68%, 92%, p < 0.001; corticosteroids, 49%, 70%, p < 0.001; nonsteroidal anti-inflammatory drugs, 34%, 85%, p < 0.001). Regarding aggressiveness of cancer care, patients received a new chemotherapy regimen within 30 days of death (3.0%),
chemotherapy within 14 days of death (4.3%), and intensive care unit admission in the last month of life (3.3%).
Conclusion We found that families, not patients, consented to DNR, and life-sustaining treatments were appropriately withheld; however,
patients on general wards received excessive hydration, and the use of palliative care drugs could be improved. Application
of our findings can be used to improve clinical care in general wards. 相似文献
2.
Many medical professionals are still confused when facing the reduction of food or fluid intake in terminal cancer patients. The aim of this study was to assess the frequency and causes of the inability of eating or drinking in terminal cancer patients and to investigate the use of artificial nutrition and hydration (ANH); the frequency, type, and the extent to which staff found ANH to be ethically justified. Three hundred forty-four consecutive patients with terminal cancer admitted to a palliative care unit in Taiwan were recruited. A structured data collection form was used daily to evaluate clinical conditions, which were analyzed at the time of admission, 1 week after admission and 48 h before death. One hundred thirty-three (38.7%) of the 344 patients were unable to take water or food orally on admission; the leading cause was GI tract disturbances (58.6%). This impaired ability to eat or drink had become worse 1 week after admission (39.1%, P<0.01) and again 48 h before death (60.1%, P<0.001). The total rate of ANH use declined significantly, from 57.0% to 46.9% 1 week after admission ( P<0.001), but rose again to the same level as at admission in the 48 h before death (53.1%, P=0.169). Parenteral hydratation could be reduced significantly 1 week after admission ( P<0.05), but no reduction was possible in the 48 h before death; nor was it possible to reduce the nutrition administered. Multiple Cox regression analysis shows that the administration of ANH, either at admission or 2 days before death, did not have any significant influence on the patients' survival (HR: 0.88, 95% CI: 0.58-1.07; HR: 1.03, 95% CI: 0.76-1.38). In conclusion, sensitive care and continuous communication will probably lessen the use of ANH in terminal cancer patients. We have found it easier to reduce artificial hydratation than artificial nutrition, which corresponds to local cultural practice. Whether or not ANH was used did not influence survival in this study. Thus, the goals of care for terminal cancer patients should be refocused on the promotion of quality of life and preparation for death, rather than in simply making every effort to improve the status of hydratation and nutrition. 相似文献
3.
Introduction This study aimed to investigate the effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions
regarding supplying artificial nutrition and hydration (ANH) to terminal cancer patients.
Materials and methods A quasi-experimental design was adopted. A structured questionnaire evaluated the effects of educational intervention. From
April to June 2005, 88 nurses were enrolled in the gastroenterology, general surgery, and intensive care unit of Taipei Veterans
General Hospital in Taiwan. The nurses were randomly assigned into experimental and control groups in equal numbers (44 nurses
in each group). After the experimental and control groups completed the pretest, the experimental group participated in a
50-min lecture. Both groups received a post-test 2 weeks after the lecture.
Results This study showed that prior to educational intervention, nurses have possessed experiences of ANH use in routine caring for
terminal cancer patients. However, due to the lack of knowledge about supplying ANH to terminal cancer patients, the nurses
trended toward the negative behavioral intention, although they realized the burdens of ANH in these patients. After educational
intervention, mean scores of knowledge, attitudes and behavioral intentions of the experimental group increased significantly
(z = −5.255, p < 0.001; t = −5.191, p < 0.001; z = −3.274, p ≦ 0.001). Mean score changes of knowledge and attitude between these two groups reached significant differences (t = −7.306, p < 0.001; t = −4.165, p < 0.001), but no significant difference was observed in the mean score change of behavioral intention (z = −1.943, p > 0.05).
Conclusion The educational intervention remarkably improved nurses’ knowledge and attitudes regarding supplying terminal cancer patients
with ANH. As for the changes in the behavioral intentions, it requires long-term moral and ethical training and communication.
The results of this research emphasized the importance of educational interventions, which should be considered seriously
in future reference nursing education program. 相似文献
4.
This paper reports a prospective study conducted between September 1997 and July 1998 in 232 consecutive patients with terminal
cancer. A structured data collection form was used daily to evaluate symptoms, which were analyzed at the time of admission,
1 week after admission and 48 h before death. Terminal cancer patients in this study were polysymptomatic. There were no statistically
significant differences in the prevalence of most symptoms with the primary site of cancer. The majority of symptoms improved
at the end of the 1st week after admission, but many symptoms worsened just before death. The high prevalence of symptoms
and lack of significant difference among primary tumor sites may be related to shorter survival times caused by late referral,
which is common in Taiwan.
Published online: 17 January 2000 相似文献
5.
Background Obesity is a well-known problem in children with acute lymphoblastic leukemia (ALL), and it might be the result of an excess
in energy intake, reduced energy expenditure, or both. The aim of this study is to describe energy intake and physical activity
during treatment for ALL with intermittent dexamethasone (DEXA).
Methods Body mass index (BMI), energy intake, and physical activity were measured in 16 ALL patients on maintenance treatment and
in 17 healthy controls. ALL patients were measured during (“on DEXA”) and in between (“off DEXA”) DEXA treatments.
Results In patients, the mean increase in BMI z-score was 1.4 ± 1.1. Energy intake on DEXA was higher (2,125.9 ± 476.0 vs 1,775.1 ± 426.1 kcal/24 h,
p < 0.05) and energy intake off DEXA was lower (1,305.0 ± 249.4 vs 1,775.1 ± 426.1 kcal/24 h, p < 0.05), compared to healthy controls. Physical activity on DEXA was lower compared to healthy controls (30.0 ± 3.9 vs 40.0 ± 6.0 kcal
kg−1 24 h−1, p < 0.001 and 7,303.1 ± 4,622.9 vs 13,927.2 ± 3,822.7 steps, p < 0.05). Physical activity off DEXA was not different compared to healthy controls.
Conclusion Weight gain in patients on ALL treatment might be owing to increased energy intake and decreased physical activity during
treatment with DEXA. 相似文献
6.
Marylou Cárdenas-Turanzas María Teresa Carrillo Horacio Tovalín-Ahumada Linda Elting 《Supportive care in cancer》2007,15(3):243-249
Objective To improve the care of cancer patients by understanding the factors associated with the place of death.
Patients and methods We conducted a retrospective study of death certificates registered in Mexico during 2003. Adult cases were included if the
underlying cause of death was cancer, death location was in the Mexico City Metropolitan Area (MCMA), and information was
available on sociodemographic characteristics and place of death (home or medical unit).
Main results Of the 10,561 cases meeting the inclusion criteria, 54% died at home. More women (55%) than men died of cancer and at a younger
age (63 vs 64 years, respectively; p < 0.001). Multivariate analysis indicated that patients diagnosed with leukemia and lymphoma were 3.6 times more likely to
die in hospitals than patients diagnosed with other cancers (p < 0.001). Compared with patients who died at home, patients who died in hospitals were significantly more educated, younger,
and residents of counties with more hospital beds density (p < 0.001, p < 0.001, and p = 0.003, respectively). Certificates for in-hospital deaths were more likely to be signed by other physician or health professional
than were those for at-home deaths (p < 0.001). Cases with usual residency located outside the study area were 27 times more likely to die in hospitals than were
metropolitan-area residents (p < 0.001).
Conclusions Patients dying at home tended to be of older age, less educated, diagnosed with prostate, urinary tract or gastrointestinal
cancers, and residents of the MCMA. Health planners should consider determinants of place of death when allocating hospital
or home-based palliative care units. 相似文献
7.
Helen Innes Sheow Lei Lim Allison Hall Su Yin Chan Neeraj Bhalla Ernest Marshall 《Supportive care in cancer》2008,16(5):485-491
Goals of work Febrile neutropenia (FN) represents a spectrum of severity in which low-risk patients can be defined using the Multinational
Association for Supportive Care in Cancer (MASCC) risk index. However, despite publication in 2000, there remains limited
published literature to date to support the use of MASCC risk assessment in routine clinical practice and eligibility for
early hospital discharge. In this study, we present our experience with the routine use of the MASCC risk index to determine
the management of FN in our institution.
Patients and methods Patients treated for solid tumours or lymphomas with low-risk FN (MASCC score ≥21) were eligible for oral antibiotics (ciprofloxacin
plus either co-amoxiclav or doxycycline) and for early hospital discharge irrespective of first or subsequent episode. The
primary outcome was rate of resolution of FN without serious medical complications (SMC). Secondary outcomes were the “success”
of antibiotic therapy without treatment modifications, duration of hospitalisation and rate of readmissions.
Results A total of 100 FN episodes occurring in 83 patients were treated over a 6-month period. Ninety of these episodes were low-risk
(90%), of which 75 received oral antibiotics (83.3%) and 3 (3.3%) experienced SMC, and the success rate was 94.5% [95% confidence
interval (CI) 89.6–99.3%] in low-risk episodes. The median duration of hospitalisation was 2.5 days (25th centile: 1.0 day;
75th centile: 5.0 days) in low-risk compared to 6.5 days (25th centile: 5.3 days; 75th centile: 9.3 days) in high-risk episodes
(p = 0.003); 2 days for low-risk episodes treated with oral antibiotics compared to 4 days for low-risk receiving intravenous
antibiotics (p = 0.015). Positive predictive value for the MASCC index was 96.7% (95% CI 95.0–98.6%).
Conclusion The MASCC risk index is both feasible and safe when used in standard clinical practice to guide the management of FN in patients
with solid tumours and lymphomas. Patients predicted to have low risk can be managed safely with oral antibiotics and early
hospital discharge. 相似文献
8.
Haidy Lee Carole Havrila Vikki Bravo Kellie Shantz Kellie Diaz James Larner Paul Read 《Supportive care in cancer》2008,16(3):285-289
Goals Malnutrition in the head and neck cancer population is a widely recognized factor contributing to negative outcomes. The goal
of this study was to determine if providing complimentary oral nutritional supplementation for patients undergoing definitive
radiation therapy for oropharyngeal carcinoma reduced weight loss and the need for percutaneous endoscopic gastrostomy (PEG)
tube placement.
Materials and methods The data from 79 patients undergoing radiotherapy for oropharyngeal cancer were extracted and analyzed retrospectively from
an institutional Human Investigation Committee approved database for the study of advanced radiation therapy techniques for
head and neck cancer. Forty patients were treated before the initiation of a nutritional supplementation program, and 39 patients
received supplementation. Patients were stratified by type of treatment (radiation alone or chemoradiation) and whether or
not they had a PEG tube.
Results All patient groups receiving supplementation manifested a significant decrease in weight loss compared to those who did not
receive it. Nutritional supplementation was associated with a 40% relative reduction in weight loss in patients treated with
radiotherapy alone (6.1 vs 10.1%, p = 0.008) and a 37% reduction in weight loss in patients treated with chemoradiotherapy (6.7 vs 10.7%, p = 0.007). When patients were stratified by the presence or absence of a PEG tube, both groups experienced a 39% relative
reduction in weight loss (with PEG, 5.7 vs 9.3%, p = 0.028; without PEG, 6.9 vs 11.2%, p = 0.002). Supplementation was associated with a decreased need for PEG tube placement (31% decreased to 6%) in patients treated
with radiotherapy alone.
Conclusions Providing complimentary oral nutritional supplementation significantly decreases weight loss and the need for PEG tube placement
in patients undergoing radiation therapy for oropharyngeal cancer. 相似文献
9.
Eylem Sahin Cankurtaran Elvan Ozalp Haldun Soygur Derya Iren Akbiyik Levent Turhan Necati Alkis 《Supportive care in cancer》2008,16(11):1291-1298
Goals of the work This study aimed to compare the effectiveness of mirtazapine and imipramine on not only the distressing symptoms of cancer
patients such as pain, nausea, vomiting, appetite loss, and sleep disturbances but also depressive and anxiety symptoms.
Materials and methods Fifty-three patients with cancer who were diagnosed with major depressive disorder, anxiety disorder, or adjustment disorder
were included. Twenty patients on mirtazapine, 13 patients on imipramine, and 20 patients in the control group without medication
were interviewed during three visits (baseline, third week, and sixth week). Pain, nausea, vomiting, appetite loss, and sleep
disturbances were evaluated with self-assessment single-symptom scales during each visit. The patients were also asked to
complete the Hospital Anxiety Depression Scale (HADS) during each visit.
Main results There were no significant differences among the three visits in the mirtazapine, imipramine, or control groups in terms of
pain, nausea, vomiting, or appetite loss. For the initial, middle, and late insomnia, only the mirtazapine group showed improvements
(p = 0.001, p = 0.001, p = 0.003). There were also significant differences in the mean total (p = 0.03), anxiety (p = 0.003), and depression (p = 0.025) scores of HADS among the three visits for patients taking mirtazapine. There were no significant differences for
HADS scores from the baseline to the end point for patients taking imipramine or control group patients.
Conclusion Our findings suggest that mirtazapine is effective for resolving insomnia as well as anxiety and depressive symptoms in cancer
patients. However, more systematic research, such as placebo-controlled studies, is needed. 相似文献
10.
Jane A. Read Philip J. Beale Dianne H. Volker Narelle Smith Annabel Childs Stephen J. Clarke 《Supportive care in cancer》2007,15(3):301-307
Goals The aim of the study was to assess the impact of an eicosapentanoic acid-containing protein and energy dense oral nutritional
supplement (EPA-ONS) on nutritional and inflammatory status, quality of life (QOL), plasma phospholipids (PPL) and cytokine
profile, tolerance of irinotecan-containing chemotherapy and EPA-ONS in patients with advanced colorectal cancer (CRC) receiving
chemotherapy.
Materials and methods Patients with advanced CRC having one prior chemotherapy regimen received 480 ml of EPA-ONS daily for 3 weeks before commencing
chemotherapy with folinic acid, 5-fluorouracil, irinotecan (FOLFIRI), and continued for 3 cycles of treatment (9 weeks). All
assessments including weight, body composition, C-reactive protein (CRP), QOL, dietary intake, PPL and cytokine analyses were
performed at baseline, 3 and 9 weeks.
Results Twenty-three patients were enrolled, 20 completed 3 weeks, and 15 completed 9 weeks. The mean EPA-ONS intake was 1.7 tetrapaks
(408 ml) daily. There was a significant increase in mean weight (2.5 kg) at 3 weeks (p = 0.03). Lean body mass (LBM) was maintained. Protein and energy intake significantly decreased after the commencement of
chemotherapy (protein p = 0.003, energy p = 0.02). There was a significant increase in energy levels (p = 0.03), whilst all other QOL measures were maintained. PPL EPA levels increased significantly over the first 3 weeks. Mean
CRP increased by 14.9 mg/L over the first 3 weeks (p = 0.004), but decreased to baseline levels by the end of the trial. There was a significant correlation between plasma IL-6
and IL-10 concentrations and survival, and between IL-12 and toxicity.
Conclusion Dietary counseling and the provision of EPA-ONS may result in maintenance of nutritional status and QOL, however randomized
trials are required to evaluate the impact of EPA on toxicity from chemotherapy. 相似文献
11.
Goals of work C-reactive protein (CRP) has been investigated as a predictor of life expectancy in terminal cancer in one previous study.
However, the other variables such as patient’s symptom or physical examination findings were not considered. The aim of this
study is to prove serum CRP level as a predictor of survival time, considering patient’s symptoms, physical examination findings,
and various serological variables in terminally ill cancer patients with a prospective cohort design.
Patients and methods Forty-four terminally ill cancer patients were divided into two groups by serum CRP levels and followed up until death. We
adjusted the influence of some clinical and laboratory variables on survival by use of Cox’s proportional hazard model. Using
the stepwise variable selection method, we found the final model. For 19 patients, CRP levels at 2 weeks and a week before
death were compared by Wilcoxon signed ranks test.
Main results All 44 study subjects died during the study period, and the median survival time was 17 days. Survival time of the elevated
CRP group (≥2.2 mg/dl) was found to be significantly shorter than the lower CRP group in univariate analysis (hazard rate = 3.221,
P = 0.001). In multivariate analysis, elevated CRP level (≥2.2 mg/dl) was selected as one of the unfavorable indicators regarding
survival. Dyspnea and hyperbilirubinemia were also found significant predictors of shorter life expectancy in the final model.
Serum CRP levels were significantly increased between the first and the second week before death.
Conclusions Our results showed that serum CRP level can be a useful indicator predictive of survival time of terminally ill cancer patients. 相似文献
12.
Susan Thompson Aditya Bardia Angelina Tan Debra L. Barton Lisa Kottschade Jeff A. Sloan Brad Christensen DeAnne Smith Charles L. Loprinzi 《Supportive care in cancer》2008,16(1):75-82
Goals of work The objectives of this pilot trial were to assess the potential efficacy and safety of levetiracetam for the treatment of
hot flashes, a major cause of morbidity among breast cancer survivors.
Patients and methods Women, aged 18 years or more, with a history of breast cancer or those who wished to avoid estrogen because of a perceived
increased risk of breast cancer, who were experiencing bothersome hot flashes (more than or equal to 14 times per week, for
more than or equal to 1 month before study entry), were included. During the baseline week, general demographic characteristics,
hot flash information, and quality of life data were obtained. At the beginning of week 2, patients were started on levetiracetam
for a total of 4 weeks. Information about hot flashes, quality of life, and toxicity were collected during these 4 weeks and
compared with the baseline week.
Main results After treatment with levetiracetam for 4 weeks (N = 19), mean hot flash scores (frequency times mean severity) were reduced by 57%, and mean hot flash frequencies were reduced
by 53%, compared to the baseline week; both these reductions were greater than what would be expected with a placebo (20–25%
reduction). There were significant improvements in abnormal sweating (p = 0.004), hot flash distress (p = 0.0002), and satisfaction of hot flash control (p = 0.0001), when comparing data from the fourth week of treatment to the baseline week. Twenty-nine percent of the subjects
did not complete the study because of treatment-related adverse events, with the most frequently reported side effects being
somnolence, fatigue, and dizziness, usually with mild to moderate intensity.
Conclusion The results of this pilot trial suggest that levetiracetam might be an effective therapy for the treatment of hot flashes.
Further data are needed to test this hypothesis, evaluating the efficacy and toxicity of this agent.
Financial Disclosure: None 相似文献
13.
Harriët Jager-Wittenaar Pieter U. Dijkstra Arjan Vissink Bernard F. A. M. van der Laan Rob P. van Oort Jan L. N. Roodenburg 《Supportive care in cancer》2007,15(9):1045-1050
Goals of work Critical weight loss (≥5% in 1 month or ≥10% in 6 months) is a common phenomenon in head and neck cancer patients. It is unknown
which complaints are most strongly related to critical weight loss in head and neck cancer patients at the time of diagnosis.
The aim of this explorative study was to assess the prevalence of critical weight loss and to analyze risk factors for critical
weight loss in head and neck cancer patients before treatment.
Materials and methods Critical weight loss and factors reducing dietary intake were assessed in 447 patients referred to an ear, nose and throat
clinic at the time of diagnosis.
Main results In total, data of 407 patients were analyzed. Critical weight loss was present in 19% of the patients. Patients with cancer
in the hypopharynx, oropharynx/oral cavity and supraglottic larynx had the highest risk for critical weight loss. Loss of
appetite, dysphagia/passage difficulties and loss of taste/aversion were significantly (p < 0.05) associated with critical weight loss.
Conclusions Already before treatment, critical weight loss is a considerable problem in head and neck cancer patients. Critical weight
loss is frequently observed in patients with cancer in the hypopharynx, oropharynx/oral cavity and supraglottic larynx. 相似文献
14.
Background To clarify the prevalence and severity of the symptoms, 203 consecutive patients with breast, prostate and other cancers treated
mainly for palliation were surveyed.
Materials and methods The series includes 116 men and 87 women with the mean age of 65 years (range 27–86 years). The patients filled-up the Edmonton
Symptom Assessment System (ESAS) questionnaire with 11 items describing cancer-related symptoms in the visual analogue scale
(VAS).
Results Altogether, 98% of the patients reported at least 1 of the 10 symptoms. There was a significant difference in the score frequencies
between the 10 symptoms (p = 0.0001), fatigue receiving the highest frequency (50.8%) of the high scores. Fatigue was also the single most frequent
symptom reported by 86.3% of the patients, followed by pain at effort (71.5%), sleeplessness (71.1%) and depression (59.0%).
The most disturbing syndrome was pain (n = 48, 23.9%), followed by fatigue (n = 28, 13.9%), depression (9.5%) and dyspnoea (6.0%). Altogether, 75% had more than 5 symptoms and 10% reported all 10 symptoms.
The total number of symptoms was not significantly associated with sex (p = 0.781) or age (p = 0.062), but it was associated with the diagnostic group; patients with breast cancer (n = 41) and those with prostate cancer (n = 44) reported fewer symptoms than the patients with other cancers (n = 116)(p = 0.023, Kruskal–Wallis).
Conclusions Symptoms related to cancer are common among patients treated with palliative indication, but if not specifically surveyed,
may remain un-detected and un-treated. ESAS as a clinical tool brings more symptoms to the attention of the physicians and
helps in getting a comprehensive insight into the patient’s problems. 相似文献
15.
R. Kallio H. Aalto A. Takala P. Ohtonen J. Collan S. Siitonen H. Joensuu H. Syrjala H. Repo 《Supportive care in cancer》2008,16(12):1389-1396
Goals of work No blood marker available to date is useful for distinguishing infection-related from neoplasm-related fever. We evaluated
the expression of the peripheral blood phagocyte CD11b/CD18 adhesion molecule complex for this purpose.
Materials and methods Neutrophil and monocyte CD11b/CD18 expression was assessed in two cohorts of patients with advanced solid cancer (n = 120) and in healthy controls (n = 63). The cancer series included 89 patients with verified infection, 23 without infection, and eight with neoplastic fever.
CD11b/CD18 expression was measured using flow cytometry, and serum C-reactive protein (CRP) concentration was determined with
immunoturbidimetric assay.
Results Cancer patients with infection had higher blood neutrophil and monocyte CD11b/CD18 expression levels than patients with neoplastic
fever, those with advanced cancer without infection, or healthy controls (p < 0.01 for all analyses). High CD11b/CD18 values were measured exclusively in individuals diagnosed with infection. Receiver-operating
characteristic area under the curve (AUC) for neutrophil and monocyte CD11b/CD18 expression for the discrimination of infection
from neoplastic fever was 0.80 (95% CI, 0.70 to 0.88), which was superior (p = 0.039 and p = 0.049, respectively) to serum CRP on admission (AUC 0.51, 0.40 to 0.62).
Conclusions Peripheral blood phagocytic cell CD11b/CD18 expression is useful for making a differential diagnosis between infection and
neoplasm-related fever in cancer patients.
R. Kallio and H. Aalto equally contributed to the present study. 相似文献
16.
Eduardo Bruera M.D. Michele Belzile R.N. B.Sc.N. Sharon Watanabe M.D. Robin L. Fainsinger M.D. 《Supportive care in cancer》1996,4(2):147-150
In this retrospective study we reviewed the volume and modality of hydration of consecutive series of terminal cancer patients in two different settings. In a palliative care unit 203/290 admitted patients received subcutaneous hydration for 12 ± 8 days at a daily volume of 1015 ± 135 ml/day. At the cancer center, 30 consecutive similar patients received intravenous hydration for 11.5 ± 5 days (P > 0.2) but at a daily volume of 2080 ± 720 ml/day (P < 0.001). None of the palliative care unit patients required discontinuation of hydration because of complications. Hypodermoclysis was administered mainly as a continuous infusion, an overnight infusion, or in one to three 1-h boluses in 62 (31%), 98 (48%) and 43 (21%) patients, respectively. Our findings suggest that, in some settings, patients may be receiving excessive volumes of hydration by less comfortable routes such as the intravenous route. Increased education and research in this area are badly needed. 相似文献
17.
Lone Ross Annemette G. Abild-Nielsen Birthe L. Thomsen Randi V. Karlsen Ellen H. Boesen Christoffer Johansen 《Supportive care in cancer》2007,15(5):505-513
Goals of the work As part of a psychosocial intervention study, we wanted to prospectively assess the quality of life of colorectal cancer patients
who were given a stoma at the time of their initial operation for cancer or later and those whose initial stoma was removed.
Materials and methods A total of 249 colorectal cancer patients were recruited and responded to a questionnaire 3, 6, 12 and 24 months after the
initial operation (26–35% had a stoma during follow-up).
Main results Although most of the differences between stoma and non-stoma patients failed to reach significance, 22 out of 27 variables
indicated a poorer quality of life for those with a stoma. Patients who currently had a stoma had significantly higher levels
of depression (p = 0.013), poorer social functioning (p = 0.0085) and more problems with body image (p = 0.0001), future perspectives (p = 0.0058), micturition (p = 0.018) and side effects from chemotherapy (p = 0.008), but fewer problems with constipation (p = 0.034) than non-stoma patients. Male patients with a stoma had more sexual problems than males without a stoma (p = 0.015). Among those with a current stoma, quality of life seemed poorer among those whose stoma was made during follow-up
compared with those with an initial stoma.
Conclusions Trends suggested that having a stoma led to poorer scores in most aspects of quality of life and that having a stoma made
some time after the initial operation was more distressing than having a stoma made during the primary cancer operation. 相似文献
18.
19.
Oral mucositis and outcomes of allogeneic hematopoietic stem-cell transplantation in patients with hematologic malignancies 总被引:1,自引:0,他引:1
Montserrat Vera-Llonch Gerry Oster Colleen M. Ford John Lu Stephen Sonis 《Supportive care in cancer》2007,15(5):491-496
Goals of the work To assess the relationship between oral mucositis (OM) and adverse clinical and economic outcomes in patients with hematologic
malignancies receiving allogeneic hematopoietic stem-cell transplantation (HSCT).
Materials and methods A retrospective chart review study of 281 allogeneic HSCT recipients with hematologic malignancies was undertaken at a single
academic center. OM extent and severity were assessed across eight oropharyngeal sites using a validated scale, which was
scored as follows: no erythema/ulceration=0; erythema only=I; ulceration, one site=II; ulceration, two sites=III; ulceration,
three sites=IV and ulceration, four or more sites=V. OM assessments began on the day of conditioning and continued twice weekly
within 28 days or hospital discharge. Analyses examined the relationship between the worst OM grade and selected adverse outcomes,
including days with fever, days of total parenteral nutrition (TPN), days of parenteral narcotic therapy, incidence of significant
(common terminology criteria (CTC) grade 3 or 4) infection, mortality and inpatient days and charges.
Main results The mean age of the study subjects was 41 years. Of the patients, 96% (n = 269) received total body irradiation and 76% (n = 214)
experienced an OM grade of ≥II (i.e., ulceration). The worst OM grade was significantly (p < 0.05) associated with the number of days of TPN and parenteral narcotic therapy, number of days with fever, incidence of
significant infection, time in hospital and total inpatient charges.
Conclusions OM is associated with worse clinical and economic outcomes in patients with hematologic malignancies undergoing allogeneic
HSCT. 相似文献
20.
M. T. Genot-Klastersky J. Klastersky F. Awada A. Awada P. Crombez M. D. Martinez M. F. Jaivenois M. Delmelle G. Vogt N. Meuleman M. Paesmans 《Supportive care in cancer》2008,16(12):1381-1387
Background Low-energy laser (LEL) treatment has been suggested as an effective and safe method to prevent and/or treat oral mucositis
induced by chemotherapy and/or radiotherapy; however, it has not gained wide acceptance so far.
Materials and methods We conducted two clinical trials testing the LEL technique: firstly, as a secondary prevention in patients with various solid
tumors treated with chemotherapy who all developed severe mucositis after a previous identical chemotherapy and, secondly,
as therapeutic intervention (compared to sham illumination in a randomized way) in patients with hematological tumors receiving
intensive chemotherapy and having developed low-grade oral mucositis.
Results We entered 26 eligible patients in the first study and 36 were randomized in the second study. The success rate was 81% (95%CI = 61–93%)
when LEL was given as a preventive treatment. In the second study, in patients with existing lesions, the therapeutic success
rate was 83% (95%CI = 59–96%), which was significantly different from the success rate reached in the sham-treated patients
(11%; 95%CI = 1–35%); the time to development of grade 3 mucositis was also significantly shorter in the sham-treated patients
(p < 0.001).
Conclusion Our results strongly support the already available literature, suggesting that LEL is an effective and safe approach to prevent
or treat oral mucositis resulting from cancer chemotherapy. 相似文献