姑息治疗对晚期肿瘤患者疲乏及生活质量的影响

目的 观察姑息治疗对晚期肿瘤患者疲乏及生活质量的影响.方法 82例晚期肿瘤患者随机分为研究组与对照组,进行不同方式的姑息治疗,治疗前后对所有患者的疲乏程度及生活质量进行调查.所用量表为简易疲乏评估量表简表、世界卫生组织生活质量简表.结果 治疗前两组患者疲乏程度及生活质量差异不明显(P＜0.05).干预治疗后研究组疲乏程度较干预前明显减轻,明显轻于对照组,生活质量得分也显著高于对照组(P＜0.05).结论 全面的姑息治疗可缓解晚期肿瘤患者疲乏,提高其生活质量.     

ERCP治疗十二指肠梗阻二例

晚期的胰头、胆管下端、壶腹周围肿瘤会导致胆道梗阻,同时也会引起十二指肠的梗阻,此类患者的姑息治疗需要同时解决胆道和肠道的梗阻,有一定的难度,本文介绍2例不同患者的治疗过程。     

晚期鼻咽癌患者调强放疗治疗的2年生存率及预后影响因素分析

目的探讨晚期鼻咽癌患者调强放疗治疗的2年生存率及其预后影响因素。方法选取本院收治的晚期鼻咽癌患者80例为研究对象,患者均接受调强放射治疗(IMRT)。放疗结束4周后,评估放疗效果;随访2年,分析患者的2年生存情况,对影响患者预后的因素进行单因素和多因素Logistic回归分析。结果放疗结束4周后,患者的肿瘤控制率为88. 75%;放疗结束后2年患者无进展生存率为65. 0%、总生存率为77. 5%。多因素Logistic回归分析结果显示,年龄、肿瘤T分期及N分期是影响晚期鼻咽癌患者预后的独立因素,姑息性手术治疗是改善患者预后的保护因素。结论调强放疗治疗晚期鼻咽癌患者可获得较高的肿瘤控制率;高龄、T分期、N分期是晚期鼻咽癌患者预后的独立影响因素,姑息性手术治疗有助于改善患者预后。     

自膨式金属支架治疗结直肠恶性梗阻30例临床体会

晚期结直肠癌造成的梗阻,手术治疗风险大、效果差.支架置入术是解决部分晚期结直肠癌造成的梗阻的有效手段,与传统外科开放手术相比,具有痛苦小、安全、简便、住院时间短、恢复快、重复性强、能维持正常生理排泄通道的特点,易被医患双方接受.可对失去外科手术机会的晚期肿瘤患者及放弃手术治疗的患者提供姑息性解除结肠梗阻的治疗机会,对于改善患者生活质量和生存率具有积极的意义.     

胆囊癌根治切除新进展

胆囊癌的治疗,主要分为治愈性治疗处理早期而没有扩散的肿瘤和姑息性治疗处理晚期各种肿瘤扩散的患者。由于胆囊癌对化放疗的反应都不理想,外科切除是唯一有效的治愈性手段。1治愈性治疗胆囊癌治愈性治疗,除了肿瘤早或晚期外,其它主要因素决定于胆囊癌诊断的时间。1.1术前怀疑或诊断为胆囊癌这些患者不应接受腹腔镜胆     

姑息治疗对老年晚期胃肠道肿瘤患者生活质量的改善作用

老年恶性肿瘤患者是一个特殊的群体,给老年患者带来躯体功能、生理功能、精神状态等方面的巨大变化〔1〕。有研究提示老年恶性肿瘤患者生活质量各维度均明显降低,并随营养状况的下降而降低〔2〕。如何使老年晚期肿瘤患者在最少生理痛苦下生存更是值得探讨。笔者拟探讨姑息治疗对老年晚期胃肠道肿瘤患者生活质量的改善作用,为临床工作提供参考依据。1资料与方法1.1一般资料我院2011年2月至2012年1月收治的老年     

晚期肿瘤患者辅助使用胎盘多肽在姑息医学治疗中的应用

姑息医学是临床中一个重要的分支,研究对象主要是进展与预后不佳的一些晚期恶性肿瘤患者,治疗的目的主要是提高患者的生活质量[1].胎盘多肽是临床中治疗晚期肿瘤患者的一种重要药物.本文对晚期肿瘤患者使用胎盘多肽进行治疗,分析其应用效果. 1 资料与方法 1.1 一般资料选取我院2012年1～4月收入的177例晚期恶性肿瘤患者,男100例,女77例,年龄55～82[平均(67.4±3.4)]岁.将其随机分为三组,胎盘多肽组(PPS组)102例,对照组25例,中医组50例,三组的基本资料比较无明显差异,具有可比性.     

双介入疗法姑息性治疗晚期恶性胰腺肿瘤

目的探索晚期胰腺癌姑息性治疗方法,提高患者生活质量,延长生存时间。方法晚期恶性胰腺肿瘤患者85例,应用Seldingner技术行供血动脉插管介入化疗,并对其中53例消化道梗阻者行腔内支架安置术。结果供血动脉插管介入化疗2个月后复查统计85例中,CR6例,PR46例,无变化29例,肿瘤增大4例,有效率(CR+PR)为61.18%;支架置入者1个月后复查阻塞性黄疸或十二指肠梗阻症状均缓解;全组病例生存时间3～51个月,平均19.5个月。结论双介入疗法姑息性治疗晚期恶性胰腺肿瘤能起到提高生活质量,延长生存期的目的。     

恶性梗阻性黄疸的外科姑息治疗进展

梗阻性黄疸分为良性及恶性。恶性梗阻性黄疸由于起病隐匿,初诊时多已丧失根治术机会,因此外科姑息性治疗对于晚期恶性梗阻性黄疸患者尤为重要。本文就当前恶性梗阻性黄疸的各种外科姑息性治疗作一阐述。选择合适的外科姑息性治疗方式对晚期恶性梗阻性黄疸患者有重要意义。     

肝外胆管癌内镜治疗进展

由于绝大多数肝外胆管癌发现时已经晚期, 患者预后差, 以往多采用胆道支架置入术作姑息性引流治疗。由于没有针对肿瘤治疗, 单纯支架置入仅能缓解患者黄疸症状, 不能改善预后。光动力疗法和射频消融是近年来兴起的胆管癌局部治疗方式, 可以减少肿瘤负荷, 多项研究证实了它们在肝外胆管癌治疗中的安全性及有效性。本文就肝外胆管癌的内镜治疗方式及相关进展作一综述。     

舒缓护理在晚期结直肠癌合并肠梗阻患者中的应用探索

目的探讨舒缓护理在晚期结直肠癌合并肠梗阻患者中的应用。 方法收集2015年3月到2017年3月两年间对晚期结直肠癌合并肠梗阻的患者采取常规护理基础上给予舒缓护理的326例,于舒缓护理前后进行及时问卷调查或访谈,了解患者生理和生活质量等各项指标的变化情况。 结果晚期结直肠癌合并肠梗阻的患者在接受常规基础上的舒缓护理后,肠梗阻症状及其导致的其他不适症状如睡眠质量差、焦虑、烦躁等症状得到很好改善,更愿意与医护人员主动进行交流,对疾病治疗和生活更有信心,患者与家属情绪更和缓,关系更和谐。 结论舒缓护理的应用有助于缓解结直肠癌合并肠梗阻患者的症状,提高患者生活质量,在临床中具有应用价值。     

The patient with incurable cancer and palliative medicine in Mexico]

This paper analyzes the potential advantages of palliative care for cancer patients in Mexico. The increasing incidence of cancer, the limited rate of cure of the most frequent cancers and limited resources make palliative care a realistic treatment option. In accordance to World Health Organization recommendations, I propose the development of palliative care in Mexico.     

Supportive and palliative care of pancreatic cancer

Pancreatic cancer is one of the most lethal malignancies. An estimated 32,300 patients will die of pancreatic cancer in year 2006. It is the tenth most common malignancy in the United States. Despite recent advances in pathology, molecular basis and treatment, the overall survival rate remains 4% for all stages and races. Palliative care represents an important aspect of care in patient with pancreatic malignancy. Identifying and treating disease related symptomology are priorities. As a physician taking care of these patients it is essential to know these symptoms and treatment modalities. This review discusses symptom management and supportive care strategies. Common problems include pain, intestinal obstruction, biliary obstruction, pancreatic insufficiency, anorexia-cachexia and depression. Success is needed in managing these symptoms to palliate patients with advanced pancreatic cancer. Pancreatic cancer is a model illness to learn the palliative and supportive management in cancer patient. It is important for oncologists to recognize the importance of control measures and supportive measures that can minimize the symptoms of advanced disease and side effects of cancer treatment.     

Palliative percutaneous endoscopic gastrostomy placement for gastrointestinal cancer: Roles,goals, and complications

Percutaneous endoscopic gastrostomy tube placement is an invaluable tool in clinical practice that has an important role in the palliative care of patients with gastrointestinal cancer. While there is no extensive data regarding the use of this procedure in patients with gastrointestinal malignancy, inferences can be made from the available information derived from studies of similar or mixed populations. Percutaneous endoscopic gastrostomy tubes can be used to provide enteral nutrition for terminal malignancies of the upper gastrointestinal tract as well as for decompression of malignant obstructions. The rates of successful placement for cancer patients with either of these indications are high, similar to those in mixed populations. There is no conclusive evidence that the procedure will help patients reach nutritional goals for those needing alimental supplementation. However, it is effective at relieving symptoms caused by malignant obstruction. A high American Society of Anesthesiologist physical status score and an advanced tumor stage have been shown to be independent predictors of poor outcomes following placement in cancer patients. This suggests the potential for similar outcomes in the palliative care of patients with advanced stage gastrointestinal cancer who may be in relatively poor physiologic condition. However, this potential should not preclude its use in patients with terminal gastrointestinal cancer considering the high rate of successful tube placement, the possible benefits and the ultimate goal of comfort in palliative care.     

The patient-driven payment model: A missed opportunity for patient-centered cancer care

Hospitalized older patients with advanced cancer who were discharged to a skilled nursing facility (SNF) for rehabilitation are unlikely to receive future cancer treatment, have high 30-day readmission rates, and high mortality yet minimal hospice use. The Medicare SNF benefit was designed to be a bridge and provide short-term nursing and rehabilitation care for patients after a hospitalization. However, advanced cancer patients churn through the health system cycling between the hospital, post-acute care facilities, and home in the last months of life. This article explores the potential impact of the patient-driven payment model, a new SNF reimbursement model introduced by the Center for Medicare and Medicaid Services in 2019, on the experience of older cancer patients. Previously, SNF reimbursement was based on the hours of rehabilitative therapy provided to patients, unintentionally incentivizing SNFs to provide more therapy resulting in long lengths of stay and increased Medicare expenditure. The new patient-driven payment model bases reimbursement on patient clinical characteristics and resources utilized during their SNF stay. We discuss the impact this payment model might have on cancer patients in the SNF setting and highlight the importance of access to palliative care for this population. We discuss challenges policymakers face in creating palliative care guidelines and developing palliative care delivery models in SNFs. We highlight the policy gaps that remain in creating a system that achieves high-quality SNF care and conclude by offering suggestions that might better incorporate a patient's illness trajectory, prognosis, and goals of care.     

Frühe palliative Führung

Despite advances in chemotherapy treatment, the prognosis for patients with advanced lung cancer still remains serious accompanied by devastating effects on physical well-being, psychological health and psychosocial care. Although chemotherapy is accepted as an effective treatment, the high prevalence of disease-specific symptoms, depressed mood and aggressive end-of-life care highlight the need for palliative care to minimise symptom distress and promote quality of life. In this context, a randomised palliative intervention trial performed by Temel et al. in Boston, USA (N Engl J Med 2010) was remarkable comparing standard oncological chemotherapy alone with an early palliative concept integrated into standard chemotherapy in patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC). The results show that those patients receiving additional palliative care had a better quality of life and less depressive symptoms than did patients assigned to the standard therapy alone. In addition, median survival of patients in the palliative care group was significantly prolonged for 2.7?months compared to standard therapy alone. Data support the incorporation of early palliative care into the therapeutic concept for metastatic NSCLC.     

Palliativversorgung von Menschen mit Demenz

Patients with dementia are an important target group for palliative care since particularly in advanced stages and at the end of life they often have complex health care and psychosocial needs. However, people with dementia have inappropriate access to palliative care. So far, palliative care focuses on cancer patients. Among other reasons, this is due to the different illness trajectories: while in cancer a relatively clear terminal phase is typical, in dementia functional decline is gradual without a clear terminal phase, making advanced care planning more difficult. Good communication among health care providers and with the patient and his/her family is essential to avoid unnecessary or even harmful interventions at the end of life (e.g., inserting a percutaneous endoscopic gastrostomy, PEG). To maintain the patient's autonomy and to deliver health care according to the individual preferences, it is important to appropriately inform the patient and the family at an early stage about the disease and problems that may occur. In this context, advanced directives can be helpful.     

Symptom Burden, Depression, and Spiritual Well-Being: A Comparison of Heart Failure and Advanced Cancer Patients

BACKGROUND  A lower proportion of patients with chronic heart failure receive palliative care compared to patients with advanced cancer. OBJECTIVE  We examined the relative need for palliative care in the two conditions by comparing symptom burden, psychological well-being, and spiritual well-being in heart failure and cancer patients. DESIGN  This was a cross-sectional study. PARTICIPANTS  Sixty outpatients with symptomatic heart failure and 30 outpatients with advanced lung or pancreatic cancer. MEASUREMENTS  Symptom burden (Memorial Symptom Assessment Scale-Short Form), depression symptoms (Geriatric Depression Scale-Short Form), and spiritual well-being (Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being scale). MAIN RESULTS  Overall, the heart failure patients and the cancer patients had similar numbers of physical symptoms (9.1 vs. 8.6, p = 0.79), depression scores (3.9 vs. 3.2, p = 0.53), and spiritual well-being (35.9 vs. 39.0, p = 0.31) after adjustment for age, gender, marital status, education, and income. Symptom burden, depression symptoms, and spiritual well-being were also similar among heart failure patients with ejection fraction ≤30, ejection fraction >30, and cancer patients. Heart failure patients with worse heart failure-related health status had a greater number of physical symptoms (13.2 vs. 8.6, p = 0.03), higher depression scores (6.7 vs. 3.2, p = 0.001), and lower spiritual well-being (29.0 vs. 38.9, p < 0.01) than patients with advanced cancer. CONCLUSIONS  Patients with symptomatic heart failure and advanced cancer have similar needs for palliative care as assessed by symptom burden, depression, and spiritual well-being. This implies that heart failure patients, particularly those with more severe heart failure, need the option of palliative care just as cancer patients do.     

Physician reimbursement for critical care services integrating palliative care for patients who are critically ill

Patients with advanced illness often spend time in an ICU, while nearly one-third of patients with advanced cancer who receive Medicare die in hospitals, often with failed ICU care. For most, death occurs following the withdrawal or withholding of life-sustaining treatments. The integration of palliative care is essential for high-quality critical care. Although palliative care specialists are becoming increasingly available, intensivists and other physicians are also expected to provide basic palliative care, including symptom treatment and communication about goals of care. Patients who are critically ill are often unable to make decisions about their care. In these situations, physicians must meet with family members or other surrogates to determine appropriate medical treatments. These meetings require clinical expertise to ensure that patient values are explored for medical decision making about therapeutic options, including palliative care. Meetings with families take time. Issues related to the disease process, prognosis, and treatment plan are complex, and decisions about the use or limitation of intensive care therapies have life-or-death implications. Inadequate reimbursement for physician services may be a barrier to the optimal delivery of high-quality palliative care, including effective communication. Appropriate documentation of time spent integrating palliative and critical care for patients who are critically ill can be consistent with the Current Procedural Terminology codes (99291 and 99292) for critical care services. The purpose of this article is to help intensivists and other providers understand the circumstances in which integration of palliative and critical care meets the definition of critical care services for billing purposes.