Esophageal cancer: therapeutic approaches and nursing care

OBJECTIVES: To review the various treatment approaches, complications, and nursing management of patients with esophageal cancer. DATA SOURCES: Review articles, staging manual, textbook chapters, and research studies. CONCLUSIONS: The diagnosis and treatment of esophageal cancer is a complicated process. Combined multimodal therapy with chemotherapy, radiotherapy, and surgery is showing promising results. However, each treatment approach has complications and side effects that must be managed. IMPLICATIONS FOR NURSING PRACTICE: Nursing care is complicated and requires coordinating various support services, patient and family education, clinical assessment, nutritional management, management of side effects, and palliative care.     

An overview of the oral complications of adult patients with malignant haematological conditions who have undergone radiotherapy or chemotherapy

The aim of this review is to look at mouth-care in adult patients with malignant haematological conditions and in particular those with disturbed immunity or bone marrow depression due to radiotherapy or chemotherapy The oral assessment tools available will be discussed Different products used and research to support their use will be examined, as well as any staging systems for their introduction to the patient's schedule The awareness of the nurses who use them will also be investigated Patient education has been found to be the most important aspect of mouth-care in the haematology patient undergoing radiotherapy or chemotherapy Further research into the area of developing a specific tool for use with haematology patients with oral problems is highlighted here, as is further liaison with dental hygienists Aspects of this review may apply more generally to other patients undergoing radiotherapy or chemotherapy     

A review of the role of emergency nurses in management of chemotherapy‐related complications

Aims and objectives. To examine the role of emergency nurses in caring for patients who receive chemotherapy in ambulatory oncology settings. Reasons for emergency department presentations are examined, specific sources of clinical risk for patients receiving chemotherapy who require emergency care are discussed and cost implications of emergency department presentations related to chemotherapy are analysed. Background. Given the increased administration of chemotherapy in ambulatory settings, emergency nurses play an important role in the management of patients undergoing adjuvant chemotherapy. Emergency departments are the major entry point for acute inpatient hospital care of complications arising from chemotherapy. Design. Systematic review. Results. Chemotherapy‐related emergency department presentations have considerable clinical and cost implications for patients and the healthcare system. Strategies to improve emergency department management of chemotherapy complications and reduction in preventable emergency department presentations has significant implications for improving cancer patients’ quality of life and reducing the cost of cancer care. Conclusions. Nurses are well placed to play a pivotal role in chemotherapy management and lead interventions such as a specialist oncology nursing roles that provide information and support to guide patients through their chemotherapy cycles. These interventions may prevent emergency department presentations for patients receiving chemotherapy in ambulatory settings. Relevance to clinical practice. Patients receiving chemotherapy require access to specialised care to manage distressing symptoms, as they are at significant clinical risk because of immunosuppression and may not exhibit the usual signs of critical illness. A team approach both within and across nursing specialities may improve care for patients receiving chemotherapy and increase effective use of healthcare resources.     

Breakthroughs in modern cancer therapy and elusive cardiotoxicity: Critical research‐practice gaps,challenges, and insights

To date, five cancer treatment modalities have been defined. The three traditional modalities of cancer treatment are surgery, radiotherapy, and conventional chemotherapy, and the two modern modalities include molecularly targeted therapy (the fourth modality) and immunotherapy (the fifth modality). The cardiotoxicity associated with conventional chemotherapy and radiotherapy is well known. Similar adverse cardiac events are resurging with the fourth modality. Aside from the conventional and newer targeted agents, even the most newly developed, immune‐based therapeutic modalities of anticancer treatment (the fifth modality), e.g., immune checkpoint inhibitors and chimeric antigen receptor (CAR) T‐cell therapy, have unfortunately led to potentially lethal cardiotoxicity in patients. Cardiac complications represent unresolved and potentially life‐threatening conditions in cancer survivors, while effective clinical management remains quite challenging. As a consequence, morbidity and mortality related to cardiac complications now threaten to offset some favorable benefits of modern cancer treatments in cancer‐related survival, regardless of the oncologic prognosis. This review focuses on identifying critical research‐practice gaps, addressing real‐world challenges and pinpointing real‐time insights in general terms under the context of clinical cardiotoxicity induced by the fourth and fifth modalities of cancer treatment. The information ranges from basic science to clinical management in the field of cardio‐oncology and crosses the interface between oncology and onco‐pharmacology. The complexity of the ongoing clinical problem is addressed at different levels. A better understanding of these research‐practice gaps may advance research initiatives on the development of mechanism‐based diagnoses and treatments for the effective clinical management of cardiotoxicity.     

Nutritional management of cancer patients in a variety of therapeutic regimens.

The various therapeutic modalities for the control of neoplastic disease create metabolic disturbances necessitating special nutritional management. Negative nitrogen balance as a result of cell destruction, especially during chemotherapy and radiotherapy, is common. Nutritional support would be beneficial both in the early and in the late stages of cancer treatment. The mode of feedings should be individualized depending on the specific problems of each patient. For successful nutrition intervention, an understanding of the rational for integrated medical, nursing and nutritional approaches in the management of the patient is important.     

Multimodality imaging evaluation of esophageal cancer: staging, therapy assessment, and complications

Esophageal cancer is among the leading causes of cancer-related deaths worldwide. The management of patients with esophageal cancer is determined to a large extent by patient performance status, location of the primary cancer, and stage of disease at presentation. Multimodality regimens combining neoadjuvant chemotherapy and/or radiotherapy followed by surgery have been increasingly used in suitable candidates with locally advanced cancer. There is substantial morbidity and mortality associated with this treatment strategy, which makes appropriate patient selection important. Endoscopic esophageal ultrasound is the optimal modality to evaluate the local extent of the primary tumor and diagnose locoregional nodal metastasis. Computed tomography is more useful in detecting distant nodal and systemic metastasis. Positron emission tomography/CT is increasingly being used in patient management and improves the accuracy of staging, particularly in the detection of distant nodal and systemic metastatic disease. In this article, we review the role of imaging in the staging, assessment of therapeutic response, and detection of recurrent disease, as well as the evaluation of therapeutic complications in patients with esophageal cancer.     

Management Strategies for Pain in Breast Carcinoma Patients: Current Opinions and Future Perspectives

Breast cancer is the most frequently encountered carcinoma in women worldwide. Pain is the most distressing symptom in patients with breast carcinoma and can occur at all stages of the disease due to the cancer per se as well as due to various diagnostic and treatment modalities. A proper pain assessment helps in identification of pain syndromes and guides in formulating analgesic strategies. Primary therapies of breast carcinoma like surgery, chemotherapy, and radiotherapy for bony metastases can cause substantial pain relief. However, multimodal analgesic approaches incorporating pharmacological, interventional as well as non-conventional techniques should be employed prior to, in conjunction with, and after primary therapies of breast cancer. The prevalence of chronic neuropathic pain following breast cancer surgery may exceed 50% by current estimates, and with the increase in life expectancy of these patients, providing adequate pain relief is of paramount importance to improve their quality of life. In this review, we discuss prevailing methods of evaluation and management of pain in patients of breast carcinoma and the new techniques that may become the mainstay of pain management protocols in future.     

霍奇金淋巴瘤治疗的研究进展

霍奇金淋巴瘤(HL)是一种治愈率较高的恶性淋巴瘤,目前的常规治疗手段可使90％早期HL患者及80％晚期患者获得长期无病生存(DFS),但治疗相关的远期并发症也日益显现.探索更为精准的HL风险分层方法,以及在保证疗效的基础上减少化疗周期、减低放射剂量的治疗方案一直为HL相关研究的重点.笔者拟就近年来HL治疗方案的相关研究进展进行综述.     

宫颈癌术前动脉介入化疗并发症分析及防护对策

[目的]分析宫颈癌术前动脉介入化疗并发症，探讨其防护对策。[方法]回顾性分析38例宫颈癌病人行术前动脉介入化疗的临床资料。[结果]本组病人临床近期有效率81．6％，手术切除率94．7％，2例进行化疗后放疗；化疗后出现白细胞严重降低4例，不同程度胃肠道反应18例，发热13例，尿潴留3例，穿刺部位血肿2例，持续性下腹痛2例，存在轻度神经系统并发症2例，造影剂变态反应1例，下肢深静脉血栓形成1例。针对以上毒副反应及各种并发症，采取积极有效的防护措施后，病人均恢复良好。[结论]术前动脉介入化疗可提高宫颈癌的近期疗效，其毒副反应较轻；针对介入并发症，采取及时有效的防护措施，是提高介入治疗安全性和成功率的关键。     

Malignant haemangiopericytoma of the pelvic retroperitoneum

A case of malignant haemangiopericytoma of the pelvic retroperitoneum is described. The patient finally died of the complications of radiotherapy. In the absence of any reported long term benefits of adjuvant radiotherapy to the lesion, the lower morbidity of chemotherapy may make this form of adjuvant therapy worthy of further evaluation.     

Small gauge central venous catheters and right atrial catheters

In conclusion, the silastic catheters are viable alternatives to peripheral venous access in patients with impaired peripheral venous integrity secondary to prior chemotherapy, extravasation, circulatory impairment, and/or phlebitis. Careful planning in anticipation of the patient's long-term vascular access needs will enable earlier placement and may reduce complications secondary to chemotherapy administration via impaired peripheral veins.The oncology nurse has a primary role in the assessment of the patient's need for central venous access. Frequency of blood sampling, chemotherapy administration schedules, requirements for blood products and intravenous medications and fluids are all influencing factors. Providing information to the patient and family about the various vascular access devices is an important role of the oncology nurse as well. Assessment of the patient and family member's abilities to care for the catheter, the home environment, and follow-up needed will help plan later care. Early patient and family education, once a vascular access device is selected, will promote patient independence at home. Meticulous catheter care by the oncology nurse when the patient is hospitalized and careful follow-up of the patient's management of the catheter will help ensure the greatest longevity and lessen the incidence of complications. They are, in one patient's words, a “life-line,” and should always be respected. Oncology nurses are in the forefront of role-modeling this respect.     

Transfusion challenges in hematology oncology and hematopoietic stem cell transplant – Literature review and local experience

Transfusion medicine plays a vital role in the supportive care of patients receiving therapy for hematology, oncology and hematopoietic stem cell transplants (HSCT). With advances in therapy with more intensive chemotherapy or radiotherapy, patients usually develop cytopenias and need frequent transfusion support with packed red blood cells, granulocyte transfusion or platelets to support them until they recover from the effect of therapy. HSCT poses unique challenges for transfusion medicine, since transplant recipients may require substantial transfusion support due to cytopenias associated with toxic medications, decreased marrow reserve, infection or their malignancy. Transfusion support has many complications, mainly immune mediated and infectious complications. Jehovah's Witness patients deny transfusions of blood products as a therapeutic option and, consequently, management of their disease with chemotherapy and stem cell transplant after myeloablative therapy is quite challenging. This review describes the challenges of transfusion support in managing hemato-oncology and stem cell transplant patients and highlights a local experience in transplanting two Jehovah's Witness patients.     

Bone metastases: the current state of knowledge and the prospects for pharmacological treatment

The management of patients with skeletal metastases includes surgery, palliative radiotherapy and systemic treatment (chemotherapy, hormonotherapy, and the use of bisphosphonates). Hormonotherapy and chemotherapy in the treatment of skeletal metastases are most frequently used in patients with breast and prostate cancer and in patients with myeloma. Bisphosphonates in patients with skeletal metastases from those tumours allow for reduction of skeletal complications and improvement of their life quality.     

Hypertension in patients with diabetes mellitus

It is well known that diabetes often induces macrovascular and microvascular complications, and hypertension is also considered to be an important risk factor for macrovascular events. Recent epidemiological studies have proved the possibility that hypertension among patients with diabetes greatly increases the risks of these complications. However, the impact of hypertension on stroke and microvascular complications is considered to be greater than that on coronary heart disease. Co-existent metabolic risk factors such as hyperlipidemia rather than hypertension may affect more coronary heart disease. Antihypertensive treatment among diabetic patients is expected to reduce various complications, but management of metabolic risk factors is also needed to prevent coronary heart disease.     

Regression of post-transplant Kaposi's sarcoma using sirolimus

Kaposi's sarcoma (KS) is a recognised complication following kidney transplantation, but the incidence varies according to the geographical area. Although it is a rare tumour, its incidence increases dramatically after solid-organ transplantation. The immunosuppressive medications reactivate human herpes virus 8, which has been proposed as the offending agent. The usual treatment of KS is to reduce immunosuppression, chemotherapy and radiotherapy. Nevertheless, the mortality still remains considerably high and has been reported between 8 and 14%. Sirolimus (SRL) has properties which may be useful in the management of some posttransplant tumours such as KS. We report a renal transplant patient with KS, who had multiple relapses after radiotherapy but responded well to the change of immunosuppression from cyclosporine to SRL.     

ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I – Assessment and Management of Various Cardiovascular Risk Factors

Cardiovascular disease contributes significantly to the adverse clinical outcomes of peritoneal dialysis (PD) patients. Numerous cardiovascular risk factors play important roles in the development of various cardiovascular complications. Of these, loss of residual renal function is regarded as one of the key cardiovascular risk factors and is associated with an increased mortality and cardiovascular death. It is also recognized that PD solutions may incur significant adverse metabolic effects in PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendations regarding lifestyle modification, assessment and management of various cardiovascular risk factors, as well as management of the various cardiovascular complications including coronary artery disease, heart failure, arrhythmia (specifically atrial fibrillation), cerebrovascular disease, peripheral arterial disease and sudden cardiac death, to be published in 2 guideline documents. This publication forms the first part of the guideline documents and includes recommendations on assessment and management of various cardiovascular risk factors. The documents are intended to serve as a global clinical practice guideline for clinicians who look after PD patients. The ISPD workgroup also identifies areas where evidence is lacking and further research is needed.     

肺结核化疗中病情恶化的原因回顾性分析

目的 了解肺结核化疗期间病情恶化的原因，性质，探讨其处理和预防措施，方法 对87例肺结核化疗中病情恶化患者的临床资料分时间段进行分析，并结合文献复习。结果 87例肺结核患者化疗中病情恶化的原因；化疗无力12例，感染耐药结核菌31例，感染其他分支杆菌3全争生变态反应7例，出现合并症34例，近5年，耐药菌的增多和合并症的出现是病情恶化的主要原因，结论 肺结核化疗期间病情恶化的原因较多，且随时间变迁而有所变化。临床需在积极抗结核的前提下，针对不同的病因采取不同的对策。     

Metabolic and anatomic thyroid emergencies: a review.

PURPOSE: To review the diagnosis and management of thyroid diseases, both metabolic (thyroid storm and myxedema coma) and anatomic (substernal goiter, lymphoma, anaplastic carcinoma) that may require intensive care therapy. DATA SOURCES: English-language articles were identified through a search of the MEDLINE and Index Medicus databases. Bibliographies of retrieved articles were examined for relevant articles. STUDY SELECTION: Approximately 250 articles were reviewed. Those articles deemed most representative were utilized. Case reports were included to highlight rare, but potentially lethal complications. DATA EXTRACTION: All data were analyzed by one observer. Limitations of the data are discussed. DATA SYNTHESIS: Guidelines for determining the etiology of thyrotoxic crisis are outlined. Criteria for distinguishing critically ill hypothyroid patients from those patients with the euthyroid sick syndrome are given. Therapy for both disorders must be aggressive and multifaceted, and detailed management is indicated. Substernal goiter is almost always benign, but may cause various acute complications, including dyspnea, respiratory failure, superior vena caval syndrome, esophageal varices (downhill), and others. Surgery almost always corrects the problem. Lymphomas present with rapid thyroid enlargement. Recent studies suggest that surgery may assume more of a supportive role, used principally to obtain adequate tissue for histologic classification. CONCLUSIONS: Thyroid disorders can produce emergencies requiring the attention of multiple medical and surgical specialists. While management is often successful, future studies should address the following three areas: a) optimization of thyroid hormone dose for treatment of myxedema coma; b) clarification of the role of radiotherapy and/or chemotherapy for thyroid lymphoma; and c) more effective therapy for anaplastic carcinoma.     

Effective chemotherapy for submandibular gland carcinoma ex pleomorphic adenoma with lung metastasis after radiotherapy: A case report

BACKGROUND Only a few cases of carcinoma ex pleomorphic adenoma arising in the submandibular gland have ever been reported,all with a poor prognosis. The standard treatment for salivary gland carcinoma ex pleomorphic adenoma is surgical resection combined with postoperative radiotherapy,but the necessity of chemotherapy as well as the most appropriate treatment regimen for patients with distant metastasis after radiotherapy remains controversial.CASE SUMMARY This report presents the case of a 73-year-old woman who suffered submandibular gland carcinoma ex pleomorphic adenoma. She accepted surgery to remove the mass; she was found to have lung metastasis after radiotherapy.Her condition was controlled by chemotherapy with liposomal doxorubicin plus cisplatin.CONCLUSION The positive clinical outcome in the patient reveals that this chemotherapy regimen may be an alternative treatment for such a condition.     

Factors influencing comfort level in head and neck neoplasm patients receiving radiotherapy

ObjectiveTo determine factors that influence comfort in head and neck neoplasm patients receiving radiotherapy.MethodsIn total, 200 head and neck neoplasm patients receiving radiotherapy were recruited from three tertiary first class hospitals. They were assessed by Radiotherapy Comfort Questionnaire for patients with head and neck neoplasm, Social Support Scale, and Medical Coping Modes Questionnaire.ResultsThe total score of comfort was 60.54 ± 8.32. Multiple linear regression analysis indicated that number of radiation treatments, family accompaniment, educational level, resignation coping mode, complications due to diabetes, accompanying chemotherapy, and the utilization of social support significantly influenced comfort level (p < 0.05). Among these, number of radiation treatments, complications due to diabetes, accompanying chemotherapy, and resignation coping were negative factors.ConclusionEncouraging utilization of social support systems and a positive coping mode is important for increasing comfort level in head and neck neoplasm patients during radiotherapy. Nurses should pay particular attention to those patients during later stages of radiotherapy or chemotherapy, with diabetes, without family accompaniment, and with lower education level.