中医药在晚期肺癌姑息治疗中的应用

肺癌在目前还不能完全治愈,大部分的中晚期患者不得不接受放疗或化疗,中医药和放化疗成为晚期肺癌很重要的姑息手段。中晚期肺癌在不能完治愈的情况下,姑息治疗显得更为需要。越来越多的临床实践证明,姑息治疗应贯穿肿瘤治疗的全过程,晚期肿瘤患者应用中医药治疗可以收到良好的治疗效果。我们在晚期肺癌治疗过程中应用中医     

不良心理状态对姑息治疗肺癌患者生活质量的影响

目的探讨分析不良心理状态对姑息治疗肺癌患者生活质量的影响。方法选取2009年2月至2013年5月间进行姑息治疗的肺癌患者148例作为观察组,选取同期健康志愿者100名作为对照组。采用焦虑评分量表(SAS)、抑郁评分量表(SDS)、心理健康评分量表(SCL-90)及生活质量评分量表(QLQ-C30)统计分析姑息治疗肺癌患者心理状态与其生活质量的关系。结果观察组患者SAS、SDS、SCL-90得分显著高于健康对照组,差异有统计学意义(P<0.05)。观察组患者的生活质量评分为(60.12±11.96)分,生活质量较差。多因素Logistic分析显示,肺癌患者的焦虑、抑郁及不良心理状态是影响患者生活质量的危险因素(P<0.05)。结论姑息治疗的肺癌患者心理状态较差,且其不良的心理状态显著影响了生活质量。     

肺癌患者化疗期间联合营养支持治疗的研究进展

原发性肺癌是最常见的恶性肿瘤之一,目前其发病率、死亡率均居第一位,在我国仍呈现上升趋势。肺癌患者常常伴有营养不良和消瘦,化疗时细胞毒药物的不良反应可能导致患者营养状况进一步恶化而降低抗肿瘤治疗疗效和患者的生活质量。随着癌症姑息治疗的发展以及患者对生存质量的更高要求,营养支持治疗将成为在化疗过程中维持患者良好的营养状态以及增强自身免疫力的重要辅助治疗手段,在提高肺癌患者化疗耐受性和改善预后等方面发挥积极作用。现就肺癌患者在化疗期间联合应用营养支持治疗的研究进展做一综述。     

评价生活质量在中医药治疗恶性肿瘤中的作用

目前治疗癌症的水平可以从一首在欧洲流传 4 0 0多年的顺口溜中得到反映 :仅有部分患者能够治愈 ,大多数患者为症状缓解 ,而全部患者均需要关怀和照顾。由于在许多国家 ,尤其发展中国家大多数癌症患者在诊断时 ,已超越了根治性治疗的范围 ,因此 ,姑息性治疗 (又称缓解性、舒缓性治疗 )在多数常见肿瘤患者中均占比较重要的地位 ,尤其在我国更加具有重要而现实的意义。ＷＨＯ确定的癌症综合控制规划包括预防、早期诊断、根治性治疗、疼痛及其他症状的控制即姑息性治疗四项重点。姑息性治疗是对已不能根治的癌症患者的一种积极、全面的治疗 ,其…     

肺癌骨转移诊治的研究进展

肺癌骨转移常严重影响患者的生活质量及生存期,因此须尽早诊断和恰当处理。骨转移的临床诊断方法包括X线平片、CT、MRI、ECT、PET等,其敏感性和特异性各有不同;新近的基因芯片技术对肿瘤微转移灶进行早期诊断,对肿瘤细胞的基因分析还有助于更好了解原发肿瘤的生物学特性及寻找有效措施早期清除微转移灶。治疗包括局部和全身治疗。外科手术主要用于预防或治疗局部压迫及骨折,放疗则为止痛的有效措施。二磷酸盐类、特别是第三代二磷酸盐类的开发,为中晚期肺癌骨转移患者的姑息治疗提供了一种方便有效的方法。此外,积极的支持对症治疗同样十分重要。     

进展期肺癌的姑息治疗

ASCO在其最新发布的肺癌患者指南中对姑息治疗持如下意见：姑息疗法包括对癌症患者机体、精神、心理和社会需求的处理。在癌症过程的初始阶段即可启动姑息疗法，并可随着患者需求的不断变化而作出相应的调整。对于肺癌患者来说，姑息疗法包括采取药品、化疗、放疗和／或其他可缓解癌症症状的手段，如疼痛和呼吸困难。患者的舒适度是各治疗阶段中需要优先考虑的问题。     

姑息性化疗对Ⅳ期非小细胞肺癌预后及生存质量的改善作用

目的探讨姑息性化疗对Ⅳ期非小细胞肺癌预后及生存质量的改善作用。方法选取Ⅳ期非小细胞肺癌患者80例,随机分为姑息性化疗组(n=40)和支持性治疗组(n=40)。支持性治疗组患者接受单纯对症支持治疗,姑息性化疗组患者接受对症支持治疗联合姑息性化疗。对2组患者的1年生存情况及生存质量进行统计分析。结果姑息性化疗组患者的1年生存率77.5%(31/40),显著高于支持性治疗组的42.5%(17/40)(P<0.05)。姑息性化疗组患者PF、RF、EF、CF、SF、GOL评分均显著高于支持性治疗组(P<0.05),FA、NV、PA、DY、SL、AL、CO、DI、FD评分均显著低于支持性治疗组(P<0.05)。结论姑息性化疗能够有效改善Ⅳ期非小细胞肺癌患者的预后及生存质量。     

恶性肿瘤姑息治疗的进展

许多恶性肿瘤患者确诊已属中晚期,姑息治疗在恶性肿瘤综合治疗中居重要地位,属于支持治疗。恶性肿瘤姑息治疗主要改善患者及家属的生活质量。文章分析恶性肿瘤姑息治疗的概念、原则、治疗方式及发展现状,以期规范化建设恶性肿瘤姑息治疗学科发展。     

心包内处理血管全肺切除术治疗非小细胞肺癌52例临床分析

目的探讨心包内处理血管全肺切除术治疗非小细胞肺癌的临床价值.方法对52例非小细胞肺癌患者行心包内处理血管全肺切除,与同期标准全肺切除术174例肺癌患者的手术死亡率、重要并发症、姑息性切除率及1,3,5年生存率进行对比.结果心包内组手术死亡率0.4%(1/52),重要并发症发生率15.4%(8/15),姑息性切除率7.7%(4/52),1,3,5年生存率分别为88.5(46/52)、46.2%(24/52)和30.8%(16/174);标准组手术死亡率2.9%(5/174),重要并发症发生率14.9%(26/174),姑息性切除率10.9%(19/174),1,3,5年生存率分别为89.7(156/174)、45.4%(79/174)和28.7%(50/174).结论心包内处理血管全肺切除术治疗非小细胞肺癌是安全有效的方法,扩大了肺癌的切除指征,提高了根治性切除率.     

促红细胞生成素在肺癌治疗中的作用

肺癌是我国最常见的恶性肿瘤之一，是我国城市发生率最高的肿瘤。虽然近年来肺癌的治疗有了很大的进展，但是总体预后仍旧很差。由于多数肺癌患者都处于疾病的进展期，因此，以缓解症状和维持生活质量为目的的姑息治疗是肺癌治疗的主要目标，甚至是最终目标。     

Frühe palliative Intervention

Background

Many patients with metastatic lung cancer suffer from physical and psychological symptoms as well as of social and spiritual concerns. The goals of therapy are usually palliative. Factors like symptom control and quality of life are important in addition to prolonged survival in these circumstances. The randomised trial by Temel et al. presented here shows that early palliative care can reduce symptoms, improve quality of life and prolong survival.

Objectives

The effect of early palliative care on quality of life and end-of-life care among ambulatory patients with newly diagnosed metastatic lung cancer was evaluated.

Materials and methods

Patients with newly diagnosed metastatic lung cancer were randomised to treatment with standard therapy or standard therapy plus early palliative care. Quality of life and mood were assessed at baseline and at 12 weeks with the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale (HADS). The primary outcome was the change in quality of life at 12 weeks. The data of end-of-life care were collected from electronic medical records.

Results

The palliative care group had significantly better quality of life and less depression. The end-of-life care was less aggressive and hospice care was integrated earlier and more often. The survival time was significantly prolonged.

Conclusion

These data support the approach to integrate palliative care by a multiprofessional team early in the therapeutic concept for patients with newly diagnosed metastatic lung cancer.     

Psycho-oncology

Total palliative care from the early phase of cancer treatment is recommended to relieve both physical and psychological distress. To accomplish total palliative care, psycho-oncology plays an important role in psychological care. Psycho-oncology investigates the relationship between cancer and psychological issues, and has two aspects. The first and main aspect is to investigate the influence of cancer on the psychological status of patients with cancer. The other aspect is to investigate the influence of psychological issues on survival of patients with cancer or its prevention. In fact, psychological symptoms are frequent in patients with cancer, and depression is one of the most important because it could cause suicides. However, previous studies have shown that depression is often missed and untreated. Therefore, depression should be detected and treated early.     

Early diagnosis of metastatic spinal tumor is a key for effective palliative radiotherapy in patients with lung cancer

Patients with metastatic spinal tumor are the largest in number among the patients with bone tumor. It causes a severe bone pain, pathological fracture and spinal cord compression. Thus it harshly hampers patient's quality of life. We report 3 patients with lung cancer whose initial manifestation was metastatic spinal tumor. We treated the 3 patients with palliative radiotherapy and medication. Although the severe pain has improved on a numerical rating scale(NRS), but performance status(PS)and activity of daily living(ADL)of the 3 patients got worse because the disease was progressed and complicated. Generally, PS of cancer patients found by bone matastasis is low. However, it is difficult to take an effective treatment, which leads to ADL improvement. There are many choices for treating metastatic bone tumors including pain control, bisphosphonate administration, radiation therapy, strontium radiotherapy, bone cement, palliative surgery and orthotics. In addition, a development of molecular target drugs, such as Denosmab, is expected as future modality of palliative care. In conclusion, we should detect a bone metastasis in the patient with lung cancer as early as possible, and select an appropriate treatment in collaboration with each specialist for achieving the ADL and PS improvement.     

Evidence‐practice gaps in lung cancer: A scoping review

Lung cancer is a significant international health problem. Aligning clinical practice with evidence‐based guideline recommendations has the potential to improve patient outcomes. This scoping review describes evidence‐practice gaps across the diagnostic and management care pathway for lung cancer. We conducted searches of online databases Medline, PsychInfo, Cinahl and the Cochrane Library to identify studies published between 2008 and 2012. Of 614 articles screened, 65 met inclusion criteria. We identified seven evidence‐practice gaps: (1) delays in timely diagnosis and referral; (2) curative and (3) palliative treatments are under‐utilised; (4) older age and co‐morbidities influence the use of treatments; (5) the benefits of multidisciplinary team review are not available to all lung cancer patients; (6) psychosocial needs are unmet; and (7) early referral to palliative care services is under‐utilised. The scoping review highlighted three key messages: (1) there are significant challenges in the timely diagnosis and referral of lung cancer; (2) curative and palliative treatments, psychosocial support and palliative care are under‐utilised in lung cancer management; and (3) variations in treatment utilisation appear to be associated with non‐disease factors such as patient characteristics, provider practices and the organisation of health care services. Future research should focus on designing interventions to overcome variations in care.     

Supportive care versus supportive care and combination chemotherapy in metastatic non-small cell lung cancer. Does chemotherapy make a difference?

Current chemotherapy treatment of metastatic non-small cell lung cancer has demonstrated some objective responses, but is still largely palliative. This report reviews the results of a randomized trial in patients with advanced metastatic non-small cell lung cancer which compared treatment with supportive care (treatment with palliative radiation, psychosocial support, analgesics, nutritional support) to supportive care plus combination chemotherapy with cisplatin and vinblastine. Although the patients receiving combination chemotherapy had a slightly longer median survival (20.43 weeks versus 13.57 weeks), it was not statistically significant (P = 0.09). In addition, the patients receiving chemotherapy experienced serious toxicity, and showed no significant benefit in terms of quality of life as measured by Karnofsky performance status score. The authors conclude that contemporary combination chemotherapy provides only modest survival benefit to patients with advanced metastatic non-small cell lung cancer and should not be considered standard therapy. Future investigations of chemotherapy in patients with unresectable non-small cell lung cancer should continue to utilize control arms which provide high-quality supportive care.     

Comprehensive geriatric assessment and cancer care-choice of treatment and in-home palliative care executed by using advance care planning

Choice of treatment and in-home palliative care are important for the cancer care of the elderly. In recent years, comprehensive geriatric assessment (CGA), which has been developed as a multidimensional evaluation method for the elderly, has been attracting attention for cancer care as well. CGA can be a common language for the choice of treatment and in-home palliative care of elderly cancer patients. Also, advance care planning (ACP), is important as a process that supports decision making. In the future, better choices of treatment will become available, and in-home palliative care will be improved by carrying out cancer care using CGA, while continuously carrying out ACP as an organization, realizing a high quality of life (QOL) of the elderly.     

Palliative Care in Advanced Cancer Patients: How and When?

Cancer patients develop severe physical and psychological symptoms as a result of their disease and treatment. Their families commonly suffer great emotional distress as a result of caregiving. Early palliative care access can improve symptom control and quality of life and reduce the cost of care. Preliminary results show that early palliative care access can also extend survival. Unfortunately, only a minority of cancer centers in the U.S. have the two most important resources for palliative care delivery: outpatient palliative care centers and inpatient palliative care units. In this article, we use a case presentation to discuss the impact of early palliative care access in light of the currently available evidence, and we recommend ways to improve early access to palliative care through education and research.     

American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care

PURPOSE: An American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) offers timely clinical direction to ASCO's membership following publication or presentation of potentially practice-changing data from major studies. This PCO addresses the integration of palliative care services into standard oncology practice at the time a person is diagnosed with metastatic or advanced cancer. CLINICAL CONTEXT: Palliative care is frequently misconstrued as synonymous with end-of-life care. Palliative care is focused on the relief of suffering, in all of its dimensions, throughout the course of a patient's illness. Although the use of hospice and other palliative care services at the end of life has increased, many patients are enrolled in hospice less than 3 weeks before their death, which limits the benefit they may gain from these services. By potentially improving quality of life (QOL), cost of care, and even survival in patients with metastatic cancer, palliative care has increasing relevance for the care of patients with cancer. Until recently, data from randomized controlled trials (RCTs) demonstrating the benefits of palliative care in patients with metastatic cancer who are also receiving standard oncology care have not been available. RECENT DATA: Seven published RCTs form the basis of this PCO. PROVISIONAL CLINICAL OPINION: Based on strong evidence from a phase III RCT, patients with metastatic non-small-cell lung cancer should be offered concurrent palliative care and standard oncologic care at initial diagnosis. While a survival benefit from early involvement of palliative care has not yet been demonstrated in other oncology settings, substantial evidence demonstrates that palliative care-when combined with standard cancer care or as the main focus of care-leads to better patient and caregiver outcomes. These include improvement in symptoms, QOL, and patient satisfaction, with reduced caregiver burden. Earlier involvement of palliative care also leads to more appropriate referral to and use of hospice, and reduced use of futile intensive care. While evidence clarifying optimal delivery of palliative care to improve patient outcomes is evolving, no trials to date have demonstrated harm to patients and caregivers, or excessive costs, from early involvement of palliative care. Therefore, it is the Panel's expert consensus that combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden. Strategies to optimize concurrent palliative care and standard oncology care, with evaluation of its impact on important patient and caregiver outcomes (eg, QOL, survival, health care services utilization, and costs) and on society, should be an area of intense research. NOTE: ASCO's provisional clinical opinions (PCOs) reflect expert consensus based on clinical evidence and literature available at the time they are written and are intended to assist physicians in clinical decision making and identify questions and settings for further research. Because of the rapid flow of scientific information in oncology, new evidence may have emerged since the time a PCO was submitted for publication. PCOs are not continually updated and may not reflect the most recent evidence. PCOs cannot account for individual variation among patients and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient. Accordingly, adherence to any PCO is voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances. ASCO PCOs describe the use of procedures and therapies in clinical trials and cannot be assumed to apply to the use of these interventions in the context of clinical practice. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO's PCOs, or for any errors or omissions.     

Lung carcinoma

Chemotherapy for patients with advanced lung carcinoma at an early period of diseases contributes to prolonged survival. However, since survivals are limited to around 1 year, it is critical for patients to stay at home and continue their social activities under chemotherapy. As active agents such as paclitaxel, docetaxel, gemcitabine, vinorelbine and irinotecan were introduced into clinical practice, and new techniques for preventing side effects such as emesis and neutropenia were developed, chemotherapy for outpatients become feasible also in Japan. In addition, the outpatient chemotherapy, preventing oncologic emergency and early starting of palliative care are also very important for patients'quality of life (QOL) at home. This review summarizes the present status of taking care for outpatients with lung cancer.     

β-榄香烯治疗晚期非小细胞肺癌的临床应用现状及研究进展

β-榄香烯(β-elemene)是一种新型抗肿瘤中草药,具有广谱、廉价、不良反应较轻等优点,常作为晚期非小细胞肺癌(non - small cell lung cancer,NSCLC)常规治疗的辅助用药。研究发现,β-榄香烯在联合药物治疗时能够显著提高有效率,减少治疗过程中不良反应的发生。β-榄香烯配合常规放射治疗、支气管动脉灌注化疗或立体定向照射技术治疗晚期NSCLC患者可以明显缩小病灶大小,有效改善临床症状,提高生存质量,起到增效减毒的作用。同时β-榄香烯能够逆转多种药物耐药,逆转放射抵抗。β-榄香烯注射液的使用也可以提高不能耐受放化疗的晚期NSCLC患者姑息治疗及对症治疗的治疗疗效。本文就β -榄香烯在晚期NSCLC的应用现状、研究进展以及其在临床应用中应注意的问题作一综述,为更好地指导临床用药提供帮助。