居家晚期癌症病人健康功能状态的调查研究

据报道，多数癌症病人在生命晚期为居家生活。在这段时间里，虽然其病灶发生了转移，但是绝大多数晚期癌症病人仍积极地寻求照护帮助，渴望减轻症状困扰，提高生活质量。本研究拟通过问卷调查居家晚期癌症病人生理、社会、功能、情感状况的生活质量以及生理、心理症状现状，进而较全面地把握其健康功能状态，在此基础上分析生活质量的影响因素，     

社区晚期癌症病人的临终居家护理

[目的]总结社区晚期癌症病人的临终居家护理。[方法]分析、评估62例社区晚期癌症临终病人的情况,提供良好的心理护理、疼痛护理、基础护理、环境护理等。[结果]62例癌症病人的生活、饮食习惯与病前比较,基本没有变化,家属之间的感情易交流,对病人照顾周到,使病人得到安慰、痛苦减轻、生命质量提高。[结论]给社区癌症病人实施良好的临床居家护理能改善临终病人的生命质量,使临终病人在安宁、舒适的环境中尊严地离开人世。     

晚期癌症病人居家姑息照护现状及展望

对晚期癌症病人居家姑息照护的现状、居家姑息照护测量工具、开展居家姑息照护的必要性以及我国居家姑息照护中存在的问题进行综述,以期为我国开展居家姑息照护提供借鉴意见,推动我国居家姑息照护的发展,提高晚期癌症病人居家姑息照护质量。     

390例居家晚期癌症病人的全人照顾

[目的]调查全人照顾的护理对居家晚期癌症病人生活质量的影响。[方法]对390例居家晚期癌症病人采取全人照顾,参照我国1990年制定的癌症病人生活质量评分试行草案拟定问卷,分别于全人服务第14天、第30天、第60天、第90天进行随访,采用相同生活质量评分量表对病人进行干预前后的评估。[结果]为病人提供了全人照顾后,病人的生活质量明显改善(F=609.563,P=0.000)。[结论]全人照顾可明显提升肿瘤病人的生命质量。     

晚期癌症病人死亡态度的调查研究

目的了解晚期癌症病人面对死亡的态度,旨在减轻晚期癌症病人对死亡的恐惧心理,以提供更加有效、符合其实际需要的照顾与支持。方法对84例晚期癌症病人的死亡态度进行调查研究。结果生理状况好的晚期癌症病人对死亡的接受程度高于生理状况差的,差异有统计学意义(P<0.05);心理状况好的晚期癌症病人对死亡的接受程度明显高于心理状况差的病人,但差异无统计学意义(P>0.05)。结论大多数晚期癌症病人在面临即将死亡的威胁时,都害怕死亡,承受能力较低,对死亡采取回避的态度,应加强晚期癌症病人的死亡教育。     

护理干预对居家晚期癌症病人淋巴水肿的影响

淋巴水肿是由于淋巴引流功能障碍导致的组织水肿,是淋巴系统摄入与流出之间失去平衡所致[1],是癌症病人在接受抗癌治疗或疾病恶化时可能长期伴随的合并症之一。恶性肿瘤导致的淋巴结转移和放化疗是淋巴水肿的最常见原因[1]。高蛋白的组织液积累于单侧或双侧肢体,不仅造成水肿部位肿胀、疼     

居家姑息照护对晚期癌症病人生活质量的影响

[目的]探讨姑息照护对居家晚期癌症病人生活质量的影响。[方法]将4个社区居家晚期癌症病人分为观察组39例,对照组30例。观察组进行姑息照护,对照组行常规照护。实施姑息照护前及实施1月后,用癌症病人生命质量测定量表(EORTCQLQ-C30)对病人进行评分。[结果]1个月后两组病人生活质量比较差异有统计学意义(P<0.05)。[结论]实施姑息照护能提高晚期癌症病人生活质量。     

居家姑息照护对晚期癌症病人生活质量的影响

[目的]探讨姑息照护对居家晚期癌症病人生活质量的影响。[方法]将4个社区居家晚期癌症病人分为观察组39例,对照组30例。观察组进行姑息照护,对照组行常规照护。实施姑息照护前及实施1月后,用癌症病人生命质量测定量表（EORTCQLQ—C30）对病人进行评分。[结果]1个月后两组病人生活质量比较差异有统计学意义（P〈0．05）。[结论]实施姑息照护能提高晚期癌症病人生活质量。     

出院后癌症病人的健康护理调查研究

目的:初步调查和探讨对出院后癌症病人进行健康护理的实践意义和价值。方法:对出院后的1584例肿瘤病人进行家庭访视护理,从社会心理因素对癌症病人的影响、癌症病人功能康复指导和评估等进行初步量化评估研究。结果:两个方面在健康护理治疗前后均有显著性差异(P<0.001)。结论:初步调查结果显示大多数癌症病人在治疗结束后,面临到的生活信念的重建、社会与家庭关系的恢复,相应生理功能的康复以及职业康复等问题是明显存在的,也是肿瘤护理实践的重要课题。     

Orphan symptoms in advanced cancer patients followed at home

Orphan symptoms are rarely assessed, particularly at home. The aim of this multicenter prospective study was to assess the prevalence of these symptoms and eventual factors possibly associated in advanced cancer patients at admission of a home care program. A prospective study was performed at three home care programs in Italy. Patients' data were collected, including age, sex, diagnosis, and Karnofsky status. Possible contributing factors were analyzed; preexisting neurological diseases, cerebral metastases, hyperthermia, diabetes, a state of dehydration clinically evident and/or oliguria, possible biochemical parameters when available, data regarding recent chemotherapy, opioids and doses, use of neuroleptics, benzodiazepine or anticonvulsants, corticosteroids, anti-inflammatory, and antibiotics were collected. Myoclonus, hiccup, sweating, pruritus, and tenesmus, either rectal or vesical, were assessed, according to a preliminary definition, at time of home care program admission. Three hundred sixty-two patients were surveyed at the three home care programs. Globally, 48 patients presented one or more orphan symptoms in the period taken into consideration, and 7 patients presented more than 1 symptom. One patient presented occasional and diffuse myoclonus. Nineteen patients presented sweating, 13 patients presented pruritus, and 14 patients presented hiccup. Finally, nine patients presented rectal or vesical tenesmus. There was a significant correlation between sweating and transdermal fentanyl use (P?=?0.044), fever (P?=?0.001), hiccup (P?<?0.0005), and vesical tenesmus (P?=?0.028). Pruritus was not associated to any factor. Hiccup was associated with gender (males, P?=?0.006) and sweating (P?<?0.0005). Vesical tenesmus was associated with fever (P?=?0.019) and sweating (P?=?0.028). Although the symptoms examined have a low prevalence in advanced cancer patients admitted to home care, the distress for patients may be high and deserve further analyses. Given the low prevalence of these symptoms, large studies are needed to find possible associated factors.     

不同家庭照顾者对晚期居家癌症病人家庭支持度、生活质量及心理状态的影响

[目的]探讨不同家庭照顾者对晚期居家癌症病人家庭支持度、生活质量及心理状态的影响.[方法]将156例晚期居家癌症病人依据家庭照顾者的不同分为配偶照顾组、子孙照顾组、旁系亲属照顾组和非亲属照顾组,采用家庭关怀度指数问卷、中国癌症病人生活质量调查问卷、症状自评量表调查其家庭关怀度指数、生活质量和心理状态.[结果]配偶照顾组和子孙照顾组病人的家庭支持度、生活质量及心理状态均好于旁系亲属照顾组和非亲属照顾组(P<0.05).[结论]不同家庭照顾者对晚期居家癌症病人的家庭支持度、生活质量和心理状态有一定影响,而由配偶及子孙照顾利于病人获得更好的生活质量和心理状态.     

Pattern of drug use by advanced cancer patients followed at home

The aim of this study was to document the drugs most commonly prescribed to control symptoms in advanced cancer patients being followed at home. We analyzed data for 128 patients admitted to a home palliative care program from January 1993 to January 1995. All patients were followed at home until death by a team consisting of doctors and nurses, and were given two or three medical examinations a week. The most frequently prescribed drugs were analgesics and drugs commonly used to prevent NSAID-induced gastric toxicity. Slow-release morphine was the analgesic used most often. Most patients received more than four drugs. Younger people received morphine more often than did older patients. CONCLUSIONS: Drug monitoring is a useful audit tool for verifying the quality and quantity of drugs prescribed for advanced cancer patients being followed at home. Pharmacological usage should be reviewed periodically and should reflect evidence-based practice.     

Opioid responsiveness-primary diagnosis relationship in advanced cancer patients followed at home

The aim of this study was to evaluate the influence of the primary cancer on pain characteristics and opioid response, in terms of analgesia and adverse effects, in advanced cancer patients followed at home. A prospective study was carried out in a sample of 434 consecutive advanced cancer patients who required opioids during the last four weeks of life. One hundred eighty-one patients received opioids for longer than the four weeks and were considered for this analysis. Demographic data, primary diagnosis, and pain mechanisms were recorded, and mean opioid doses, pain intensity, and symptoms were assessed at weekly intervals during the last four weeks of life. In the group of 181 patients, somatic pain was associated with lung, head and neck, breast, and prostate cancer (p < 0.0005), while visceral pain was associated with colorectal, gastric, liver, pancreatic, and uterine cancer (p < 0.0005). Considering all primary diagnoses, there was a significant increase in the mean opioid dose (p < 0.0005) across the four weekly periods. There was a significant decrease in pain intensity scores (p < 0.0005) in all cases. A significant dose increase was observed only for mesothelioma (p = 0. 027) when compared with other types of cancer. In all 181 cases, a significant worsening in symptom intensity was observed during the last two weeks of life (p < 0.01). This study shows that primary cancer may have an influence on pain characteristics and opioid response. Patients with some kinds of cancer may be at risk of developing severe pain syndromes or more adverse effects.     

Methadone response in advanced cancer patients with pain followed at home.

Concerns about the safety of therapy with methadone, which may arise because of its pharmacokinetic characteristics and inappropriate dosing, may deter clinicians from using this drug, especially in elderly patients. Experience is accumulating that the drug may be used safely and successfully if low doses are given initially and care is taken in the titration of the dose against the pain. A prospective study was carried out in a consecutive sample of 45 advanced cancer patients followed at home, who had never received other strong opioids for their pain. Patients were treated with an oral liquid preparation of methadone, which was administered 2-3 times daily, according to need. Doses were kept as low as possible and were titrated to achieve acceptable analgesia with minimal adverse effects. The methadone starting dose (MSD) at referral, the maximum dose of methadone (MMD), the days of methadone treatment, the use of other nonopioid analgesics, symptoms associated with methadone therapy, pain intensity, and pain mechanism were recorded. Methadone escalation index percentage (MEI%) and methadone escalation index in mg (MEI mg) were calculated from these parameters. No correlations between age and gender, and MSD, MMD, days on methadone, VAS and symptoms were found. No significant differences were found in pain mechanisms, age, and other parameters, including methadone-related symptoms. Treatment of pain with methadone provides important support to patients with cancer followed at home and the risks are low with individually titrated doses, even in older patients or in the presence of a neuropathic pain mechanism.     

Factors involved in gastrointestinal bleeding in advanced cancer patients followed at home

There is a lack of information on the frequency of symptomatic gastrointestinal bleeding in patients with advanced cancer. This group of patients presents several risk factors for developing gastrointestinal bleeding. The aim of this multicenter longitudinal survey was to assess the frequency of gastrointestinal bleeding and possible factors implicated in advanced cancer patients followed at home. A consecutive sample of 439 patients who referred to home palliative care program entered the study. Age, gender, primary cancer and known metastases, possible associated pathologies, history of peptic disease, use of previous or actual nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids, drugs used to prevent gastric complications, the occurrence of hematemesis or melena, significant anemia requiring blood transfusion, and mortality associated with the hemorrhagic event were recorded. Of 377 patients who completed the study, 18 reported gastrointestinal bleeding, and five had significant anemia requiring blood transfusion in three cases. Death was found to be related to bleeding in three patients. NSAIDs, steroids, and gastroprotectors were frequently used, either before or during home care. However, no clear relationship between age, gender, and the use of offender drugs with gastrointestinal bleeding was found. Liver involvement was frequently associated with the risk of developing gastrointestinal bleeding.     

Palliative sedation in advanced cancer patients followed at home: a retrospective analysis

ContextData regarding palliative sedation at home in dying patients are lacking.ObjectivesTo describe the frequency, indication, and modality of palliative sedation (PS) in patients followed at home.MethodsA retrospective analysis of home care cancer patients was performed. Patients who received PS before dying were selected and information about epidemiologic characteristics, indications, duration, drugs, and outcomes was collected.ResultsOf 370 medical charts of patients who died at home, 49 patients received PS before dying. PS was proposed by the team, relatives, or both in 63.3%, 4.1%, and 32.6% of cases, respectively. Delirium alone or in combination with other symptoms was the most frequent indication to begin PS. Midazolam was the most frequently used drug to initiate PS (98%), at a mean dose of 28.1 mg/day, in combination with parenteral morphine (84.7%) at a mean dose of 25.4 mg/day. At the time of death, midazolam was administered in 98% of patients (mean dose 22.3 mg/day), combined with parenteral morphine in 87.8% of patients (mean dose 28.1 mg/day). Satisfaction for physicians and principal caregivers after PS was good in 46 and 48 cases, respectively.ConclusionPS at home seems to be a feasible treatment option among selected patients and makes a potentially important contribution to improving care for those who choose to die at home.     

The course of symptom frequency and intensity in advanced cancer patients followed at home

Four hundred consecutive patients who were referred to a home palliative care program were prospectively surveyed to estimate the prevalence and severity of common symptoms according to the changes in the performance status. Patients were admitted for the presence of different symptoms and psychosocial support. Common symptoms included in a standard form were rated for severity (absent 0, mild 1, moderate 2, severe 3) for each visit. Pain intensity was rated on a numerical scale (0-10). For each level of Karnofsky performance score (K), the frequency and the worse symptom intensity were recorded until patient's death. Data from 370 patients were analyzed. Pain was effectively controlled. In the final stage, it was also less frequently observed, despite the use of lower analgesic doses in the last days of life. The peak of opioid consumption and symptom frequency and severity was found at K40. This was also the most frequent K level at admission. Some symptoms, such as nausea and vomiting, dry mouth, gastric pyrosis, and diarrhea reached a peak in frequency and severity, then decreased with the advanced stage of the disease. Other symptoms, such as dyspnea, drowsiness, weakness, and confusion tended to further increase and to have a peak at the lowest levels of K. Dysphagia and constipation progressively increased in frequency and intensity, but decreased at the end. These findings clarify the actual frequency and intensity of symptoms in a non-selected home care population with advanced cancer.