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1.
J Colloid Interface Sci ; 605: 752-765, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34365311

RESUMO

One major challenge of photothermal therapy (PTT) is achieving thermal ablation of the tumor without damaging the normal cells and tissues. Here, we designed a self-regulating photothermal conversion system for selective thermotherapy based on self-assembling gold nanoparticles (S-AuNPs) and investigated the selectivity effect using a novel home-made in vitro selective photothermal transformation model and an in vivo skin damaging assessment model. In the in vitro selective photothermal transformation model, laser irradiation selectively increased the temperature of the internal microenvironment (pH 5.5) and resulted in an obvious temperature difference (ΔT ≥ 5 °C) with that of the external environment (pH 7.4). More importantly, in the in vivo skin damaging assessment model, S-AuNPs achieved good tumor inhibition without damaging the normal skin tissue compared with the conventional photothermal material. This work provides not only a novel validation protocol for tumor thermotherapy to achieve the biosafety of specifically killing tumor cells and normal tissue but also an evaluation methodology for other precise therapy for cancers.


Assuntos
Hipertermia Induzida , Nanopartículas Metálicas , Nanopartículas , Neoplasias , Linhagem Celular Tumoral , Ouro , Humanos , Neoplasias/terapia , Fototerapia , Microambiente Tumoral
2.
J Palliat Care ; 37(1): 48-54, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34672215

RESUMO

BACKGROUND: Hospitalization is a stressful experience both for primary caregivers (PCs) and cancer patients alike. Although there is significant evidence that PCs of cancer patients can experience significant caregiver burden (CB), less is known about the relationships between PCs and patient symptom severity that influence CB. Methods: In this cross-sectional study, measures of the symptom severity were obtained from cancer patients. The PCs were assessed for CB. Associations between patients' symptoms and demographic characteristics and CB were investigated using multivariate analyses. Results: A total of 98 participants (patient-caregiver dyads) filled the questionnaires. According to the Zarit Burden Interview results, 65.3% of PCs had a high CB. Pain, tiredness, nausea, depression, drowsiness, well-being, and dyspnea had significantly higher mean values in those with high CB (p < .05). Financial difficulties, first-degree relationships with the patient, higher anxiety levels, and more pronounced tiredness appear to be the variables most predictive with high CB. Conclusion: In conclusion, the present study showed CB of PCs among a group of hospitalized incurable cancer patients. PCs of more symptomatic cancer patients had a higher CB, according to our findings. This emphasized the significance of palliative care. Appropriate guidance should be provided for the psychostress caused by the CB.


Assuntos
Neoplasias , Cuidados Paliativos , Fardo do Cuidador , Cuidadores , Estudos Transversais , Humanos , Neoplasias/terapia , Qualidade de Vida , Inquéritos e Questionários
3.
Spectrochim Acta A Mol Biomol Spectrosc ; 266: 120458, 2022 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-34619508

RESUMO

Near-infrared (NIR) photothermal therapy is an effective partner to the chemotherapy of tumors with the merits of high therapeutic ability and slight side effect on normal tissues. Herein, we synthesized gold nanorods and assembled them with L-cysteine reduced graphene oxide (AuNR@Lcyst-rGO) for efficient photothermal therapy. The high therapeutic efficacy of AuNR@Lcyst-rGO can be due to the high photothermal effect of gold nanorods and reduced graphene oxide, and the synergistic effect of them. The nontoxicity of L-cysteine also guarantees the comfortable biocompatibility of reduced graphene oxide, which is essential for the photothermal absorber used in human tissue. The results demonstrate that assembly of gold nanorods with reduced graphene oxide (AuNR@Lcyst-rGO) is a promising photothermal agent with high efficient NIR-triggered photothermal therapy efficiency, excellent stability, superior biocompatibility.


Assuntos
Grafite , Nanotubos , Neoplasias , Linhagem Celular Tumoral , Cisteína , Ouro , Humanos , Neoplasias/terapia , Fototerapia , Terapia Fototérmica
4.
Rev. enferm. UERJ ; 29: e51932, jan.-dez. 2021.
Artigo em Inglês, Português | LILACS | ID: biblio-1224598

RESUMO

Objetivo: analisar a produção do conhecimento sobre a experiência da família acerca dos cuidados paliativos da criança com câncer hospitalizada na unidade de terapia intensiva e discutir o papel da enfermagem no atendimento à família da criança com câncer frente aos cuidados paliativos. Método: revisão integrativa realizada na PUBMED, LILACS, SCOPUS, SCIELO e CINAHL entre janeiro e março de 2020. Resultados: a amostra foi composta por 13 artigos, originando duas categorias: O impacto do cuidado paliativo da criança com câncer na dinâmica familiar e o cuidado multiprofissional, em especial dos enfermeiros, à família da criança com câncer. Conclusão: os estudos revelaram o panorama nacional e internacional dos cuidados paliativos à criança com câncer e a desestruturação da dinâmica familiar nos aspectos físicos, sociais, psicológicos, e financeiros, caracterizando o período como estressante e doloroso. Os enfermeiros estabelecem condutas terapêuticas objetivando promover qualidade de vida para crianças em cuidados paliativos e seus familiares.


Objective: to examine production of knowledge on families' experience of palliative care for children with cancer hospitalized in an intensive care center and discuss the role of nursing in assisting the family of the child in palliative cancer care. Method: this integrative review was conducted on PubMed, LILACS, Scopus, SciELO and CINAHL between January and March 2020. Results: from the sample of 13 articles, two categories originated: The impact of palliative cancer care for children on family dynamics and multiprofessional care, especially by nurses, for the family of the child with cancer. Conclusion: the studies revealed the national and international panorama of palliative care for children with cancer and the breakdown of physical, social, psychological, and financial family dynamics, characterizing the period as stressful and painful. Nurses establish therapeutic approaches aimed at promoting quality of life for children in palliative care and their families.


Objetivo: analizar la producción de conocimiento sobre la experiencia familiar en los cuidados paliativos de niños con cáncer, hospitalizados en la unidad de cuidados intensivos, y discutir el papel de la enfermería en la asistencia a la familia del niño con cáncer frente a los cuidados paliativos. Método: Revisión integradora realizada en PUBMED, LILACS, SCOPUS, SCIELO y CINAHL entre enero y marzo de 2020. Resultados: La muestra estuvo conformada por 13 artículos, originando dos categorías: El impacto de los cuidados paliativos para niños con cáncer en la dinámica familiar y los cuidados multiprofesionales, especialmente de las enfermeras, a la familia del niño con cáncer. Conclusión: Los estudios revelaron el panorama nacional e internacional de los cuidados paliativos para niños con cáncer y la ruptura de la dinámica familiar en aspectos físicos, sociales, psicológicos y económicos, caracterizándolo como un período estresante y doloroso. Las enfermeras establecen enfoques terapéuticos dirigidos a promover la calidad de vida de los niños en cuidados paliativos y sus familias.


Assuntos
Humanos , Masculino , Feminino , Criança , Cuidados Paliativos , Família/psicologia , Criança Hospitalizada , Conhecimentos, Atitudes e Prática em Saúde , Unidades de Terapia Intensiva , Neoplasias/terapia , Papel do Profissional de Enfermagem , Neoplasias/enfermagem , Relações Enfermeiro-Paciente
5.
BMC Palliat Care ; 20(1): 171, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34740339

RESUMO

BACKGROUND: One way to improve the delivery of oncology palliative care in low and middle-income countries (LMICs) is to leverage mobile technology to support healthcare providers in implementing pain management guidelines (PMG). However, PMG are often developed in higher-resourced settings and may not be appropriate for the resource and cultural context of LMICs. OBJECTIVES: This research represents a collaboration between the University of Virginia and the Nepalese Association of Palliative Care (NAPCare) to design a mobile health application ('app') to scale-up implementation of existing locally developed PMG. METHODS: We conducted a cross-sectional survey of clinicians within Nepal to inform design of the app. Questions focused on knowledge, beliefs, and confidence in managing cancer pain; barriers to cancer pain management; awareness and use of the NAPCare PMG; barriers to smart phone use and desired features of a mobile app. FINDINGS: Surveys were completed by 97 palliative care and/or oncology healthcare providers from four diverse cancer care institutions in Nepal. 49.5% (n = 48) had training in palliative care/cancer pain management and the majority (63.9%, n = 62) reported high confidence levels (scores of 8 or higher/10) in managing cancer pain. Highest ranked barriers to cancer pain management included those at the country/cultural level, such as nursing and medical school curricula lacking adequate content about palliative care and pain management, and patients who live in rural areas experiencing difficulty accessing healthcare services (overall mean = 6.36/10). Most nurses and physicians use an Android Smart Phone (82%, n = 74), had heard of the NAPCare PMG (96%, n = 88), and reported frequent use of apps to provide clinical care (mean = 6.38/10, n = 92). Key barriers to smart phone use differed by discipline, with nurses reporting greater concerns related to cost of data access (70%, n = 45) and being prohibited from using a mobile phone at work (61%; n = 39). CONCLUSIONS: Smart phone apps can help implement PMG and support healthcare providers in managing cancer pain in Nepal and similar settings. However, such tools must be designed to be culturally and contextually congruent and address perceived barriers to pain management and app use.


Assuntos
Telefone Celular , Aplicativos Móveis , Neoplasias , Estudos Transversais , Humanos , Neoplasias/complicações , Neoplasias/terapia , Nepal , Manejo da Dor
6.
Rev Infirm ; 70(275): 23-24, 2021 Nov.
Artigo em Francês | MEDLINE | ID: mdl-34752353

RESUMO

The benefits of regular physical activity (PA) are essential and recognized, including for cancer patients, during and after treatment. The OncoNormandie regional cancer network therefore offers an adapted physical activity support system that facilitates access for cancer patients.


Assuntos
Exercício Físico , Neoplasias , Humanos , Neoplasias/terapia
7.
Rev Infirm ; 70(275): 35-36, 2021 Nov.
Artigo em Francês | MEDLINE | ID: mdl-34752359

RESUMO

The return back home of certain patients treated for cancer in the palliative phase requires efficient coordination of caregivers in order to guarantee the well-being of patients and the quality and safety of the care provided. Two hospital coordination nurses have developed a quality approach that aims to reinforce the security of technical care at home in a perfect coordination of all the city-hospital contributors.


Assuntos
Serviços de Assistência Domiciliar , Neoplasias , Hospitais , Humanos , Oncologia , Neoplasias/terapia , Cuidados Paliativos
8.
Artigo em Inglês | MEDLINE | ID: mdl-34770031

RESUMO

This study aimed to examine the awareness and status of cancer patients and healthcare providers (physicians, nurses and social workers) regarding community linkage, in order to establish a desirable care plan model in a future research project. The survey was conducted via two methods: face-to-face for cancer patients (n = 308) and oncology physicians (n = 210), and due to COVID-19 circumstances, online for nurses (n = 200) and social workers (n = 313). As a result, more than 95% of the healthcare providers responded that cancer patients required community-linked services and discharge plans, whereas 50.7% and 79.2% of cancer patients noted the importance of community-linked services and discharge plans, respectively. Social workers, among healthcare providers, showed the most positive experience about connecting patients to community services since 69.7% of them responded as "excellent". However, as a group, cancer patients considered the necessity of community-linked service as less important, as only 50.7% responded as agreeing it was necessary. The barriers to community linkage were the lack of communication among the different professions of healthcare providers, and the ambiguity in their roles. The findings of this study will inform future community-linked health research, policies and systems for cancer patients. In particular, an in-depth interview with cancer patients will be required to explore their lack of acknowledgment about the necessity of community-linked services. Therefore, this study is expected to contribute to the improvement and supplementation of cancer policies.


Assuntos
COVID-19 , Neoplasias , Enfermeiras e Enfermeiros , Médicos , Pessoal de Saúde , Humanos , Neoplasias/terapia , Percepção , SARS-CoV-2 , Assistentes Sociais
9.
Artigo em Inglês | MEDLINE | ID: mdl-34770070

RESUMO

Long-term cancer survivorship care is a crucial component of an efficient healthcare system. For numerous reasons, there has been an increase in the number of cancer survivors; therefore, healthcare decision-makers are tasked with balancing a finite budget with a strong demand for services. Decision-makers require clear and pragmatic interpretation of results to inform resource allocation decisions. For these reasons, the impact and importance of economic evidence are increasing. The aim of the current study was to conduct a systematic review of economic evaluations of long-term cancer survivorship care in Organization for Economic Co-operation and Development (OECD) member countries and to assess the usefulness of economic evidence for decision-makers. A systematic review of electronic databases, including MEDLINE, PubMed, PsycINFO and others, was conducted. The reporting quality of the included studies was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Each included study's usefulness for decision-makers was assessed using an adapted version of a previously published approach. Overall, 3597 studies were screened, and of the 235 studies assessed for eligibility, 34 satisfied the pre-determined inclusion criteria. We found that the majority of the included studies had limited value for informing healthcare decision-making and conclude that this represents an ongoing issue in the field. We recommend that authors explicitly include a policy statement as part of their presentation of results.


Assuntos
Neoplasias , Organização para a Cooperação e Desenvolvimento Econômico , Análise Custo-Benefício , Tomada de Decisões , Atenção à Saúde , Humanos , Neoplasias/terapia , Sobrevivência
10.
J Med Syst ; 45(12): 109, 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34766229

RESUMO

In the past decades, the incidence rate of cancer has steadily risen. Although advances in early and accurate detection have increased cancer survival chances, these patients must cope with physical and psychological sequelae. The lack of personalized support and assistance after discharge may lead to a rapid diminution of their physical abilities, cognitive impairment, and reduced quality of life. This paper proposes a personalized support system for cancer survivors based on a cohort and trajectory analysis (CTA) module integrated within an agent-based personalized chatbot named EREBOTS. The CTA module relies on survival estimation models, machine learning, and deep learning techniques. It provides clinicians with supporting evidence for choosing a personalized treatment, while allowing patients to benefit from tailored suggestions adapted to their conditions and trajectories. The development of the CTA within the EREBOTS framework enables to effectively evaluate the significance of prognostic variables, detect patient's high-risk markers, and support treatment decisions.


Assuntos
Sobreviventes de Câncer , Neoplasias , Adaptação Psicológica , Estudos de Coortes , Humanos , Neoplasias/epidemiologia , Neoplasias/terapia , Qualidade de Vida
12.
Artigo em Inglês | MEDLINE | ID: mdl-34769643

RESUMO

Home-based informal caregiving by friends and family members of patients with cancer is be-coming increasingly common globally with rates continuing to rise. Such caregiving is often emo-tionally and cognitively demanding, resulting in mental exhaustion and high perceived burden. Support for caregivers may be fostered by engagement with the natural environment. Interaction with nature is associated with mental health benefits such as stress reduction and improved well-being. The purpose of this paper was to evaluate the state of the science regarding the use of nat-ural environment interventions to support caregivers of cancer patients in the community. A comprehensive scoping review using the Arksey and O'Malley framework and the Preferred Re-porting Items for Systematic Reviews and Meta-analyses assessed natural environment therapies and mental health outcomes among cancer caregivers. Databases searched included CINAHL, PubMed, Scopus, Cochrane, and Alt HealthWatch. Findings recovered a total of five studies over a 10-year period that met criteria, demonstrating a lack of empirical evidence addressing this po-tential resource to support caregivers. Often, study appraisal was not on nature exposure, but ra-ther other aspects of the projects such as program evaluation, exercise, or complementary thera-pies. Both qualitative and quantitative designs were used but sample sizes were small. Caregivers experienced beneficial results across the various studies and future work could enhance these findings.


Assuntos
Cuidadores , Neoplasias , Família , Humanos , Saúde Mental , Neoplasias/terapia , Revisões Sistemáticas como Assunto
13.
Front Public Health ; 9: 741334, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34778176

RESUMO

The five-year survival rate of childhood cancer has increased substantially over the past 50 yr; however, racial/ethnic disparities in health outcomes of survival have not been systematically reviewed. This scoping review summarized health disparities between racial/ethnic minorities (specifically non-Hispanic Black and Hispanic) and non-Hispanic White childhood cancer survivors, and elucidated factors that may explain disparities in health outcomes. We used the terms "race", "ethnicity", "childhood cancer", "pediatric cancer", and "survivor" to search the title and abstract for the articles published in PubMed and Scopus from inception to February 2021. After removing duplicates, 189 articles were screened, and 23 empirical articles were included in this review study. All study populations were from North America, and the mean distribution of race/ethnicity was 6.9% for non-Hispanic Black and 4.5% for Hispanic. Health outcomes were categorized as healthcare utilization, patient-reported outcomes, chronic health conditions, and survival status. We found robust evidence of racial/ethnic disparities over four domains of health outcomes. However, health disparities were explained by clinical factors (e.g., diagnosis, treatment), demographic (e.g., age, sex), individual-level socioeconomic status (SES; e.g., educational attainment, personal income, health insurance coverage), family-level SES (e.g., family income, parent educational attainment), neighborhood-level SES (e.g., geographic location), and lifestyle health risk (e.g., cardiovascular risk) in some but not all articles. We discuss the importance of collecting comprehensive social determinants of racial/ethnic disparities inclusive of individual-level, family-level, and neighborhood-level SES. We suggest integrating these variables into healthcare systems (e.g., electronic health records), and utilizing information technology and analytics to better understand the disparity gap for racial/ethnic minorities of childhood cancer survivors. Furthermore, we suggest national and local efforts to close the gap through improving health insurance access, education and transportation aid, racial-culture-specific social learning interventions, and diversity informed training.


Assuntos
Sobreviventes de Câncer , Neoplasias , Criança , Grupos Étnicos , Hispano-Americanos , Humanos , Neoplasias/terapia , Avaliação de Resultados em Cuidados de Saúde
14.
Int J Qual Stud Health Well-being ; 16(1): 2001894, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34784840

RESUMO

PURPOSE: Sweden has tried to speed up the process of early cancer detection by standardization of care. This increased focus on early cancer detection provides people with a conflicting norm regarding the importance of recognizing possible cancer symptoms and the responsibility of not delaying seeking care.Based on existing norms about patients' responsibility and care seeking, this study explores how patients experience encounters with primary care physicians when they seek care for symptoms potentially indicating cancer. METHODS: Thirteen semi-structured interviews were conducted with patients receiving care for symptoms indicative of cancer in one county in northern Sweden. Data was analysed with thematic analysis. RESULTS: The common notion of describing patients as customers in a healthcare context does not sufficiently capture all aspects of what counts as being a person seeking care. Instead, people interacting with primary care face a twofold role in where they are required to take the role not only of customer but also of seller. Consequently, people shift between these two roles in order to legitimize their care seeking. CONCLUSIONS: Standardization oversimplifies the complexity underlying patients' experience of care seeking and interaction with healthcare. Hence, healthcare must acknowledge the individual person within a standardized system.


Assuntos
Neoplasias , Médicos de Atenção Primária , Atenção à Saúde , Detecção Precoce de Câncer , Humanos , Neoplasias/terapia , Atenção Primária à Saúde , Pesquisa Qualitativa
15.
Eur J Oncol Nurs ; 55: 102034, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34757271

RESUMO

PURPOSE: The aim of this systematic review was to determine the impact of specialist palliative care (SPC) consultations in outpatient settings on pain control in adults suffering from cancer. METHODS: Systematic Review. Databases CINAHL, Medline, PsychInfo, and Embase were searched in February 2021. Relevant studies were also hand-searched and gray literature was searched in February 2021. The PICO mnemonic (Population, Intervention, Comparison, and Outcome) was used to form the review question. Of 1053 potential studies identified, 10 met the inclusion criteria. Quality appraisal of included studies was conducted using the evidence-based librarian (EBL) critical appraisal checklist. RESULTS: Outcome data from 56% (n = 5/9) studies indicated a non-statistically significant reduction in pain. Narrative analysis of the remaining studies indicated a statistically significant reduction in pain in 50% (n = 2/4) of the studies, one study showed mixed results, and one study found no statistically significant improvement in pain control. In relation to secondary outcomes, results from 33% (3/9) of studies indicated statistically significant improvement in symptom control. Data from 22% (n = 2/9) of studies indicated no statistically significant improvement in the symptoms measured. Narrative analysis of the remaining four studies indicated generally mixed results. EBL scores of included studies ranged between 50% and 95.23%. CONCLUSION: Outpatient SPC consultations may have a positive impact on the control of pain and other distressing symptoms for cancer patients, however, results show mixed effects. Given that it is unclear what it is about outpatient SPC that impacts positively or otherwise on pain and symptom control.


Assuntos
Neoplasias , Cuidados Paliativos , Adulto , Humanos , Neoplasias/complicações , Neoplasias/terapia , Pacientes Ambulatoriais , Dor/etiologia , Encaminhamento e Consulta
16.
Medicina (Kaunas) ; 57(11)2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34833386

RESUMO

Background and Objectives: Individuals with cancer, especially advanced cancer, are faced with numerous difficulties associated with the disease, including an earlier death than expected. Those who are able to confront and accept the hardships associated with the disease in a way that aligns with their beliefs benefit from more positive psychological outcomes compared to those who are aware of their diagnosis but are unable to accept it. To date, there is limited research exploring factors contributing to illness and death acceptance in the context of advanced cancer in group therapy settings. Materials and Methods: The current study used a Directed Content Analysis approach on transcripts of online advanced cancer support groups to investigate if and how Yalom's existential factors played a role in the emergence of acceptance. Results: The online support group platform, combined with the help of facilitators, offered supportive environments for individuals seeking help with cancer-related distress by helping patients move towards acceptance. Some participants had already begun the process of accepting their diagnosis before joining the group, others developed acceptance during the group process, while a few continued to be distressed. Our analysis revealed the emergence of four themes related to illness acceptance: (1) Facilitator-Initiated Discussion, including sub-themes of Mindfulness, Relaxation and Imagery, Changing Ways of Thinking, and Spirituality; (2) Personal attitudes, including sub-themes of Optimism and Letting Go of Control; (3) Supportive Environment, including the sub-themes of Providing Support to Others and Receiving Support from Others; and (4) Existential Experience, which included sub-themes of Living with the Diagnosis for an Extended Amount of Time, Legacy and Death Preparations, and Appreciating life. Conclusions: With a paradigm shift to online delivery of psychological services, recognizing factors that contribute to acceptance when dealing with advanced cancer may help inform clinical practices. Future studies should explore patient acceptance longitudinally to inform whether it emerges progressively, which has been suggested by Kübler-Ross.


Assuntos
Atenção Plena , Neoplasias , Conscientização , Emoções , Humanos , Neoplasias/terapia , Grupos de Autoajuda
17.
Invest Educ Enferm ; 39(3)2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34822235

RESUMO

OBJECTIVES: To determine the impact of spiritual intervention on hope and spiritual well-being of persons with cancer. METHODS: Randomized controlled trial in which 74 patients with cancer referring to a chemotherapy ward of Shahid Rajaie Hospital in Yasuj city, Iran, were participated. The eligible patients were randomly assigned to either intervention or control group. Spiritual-based intervention was performed based on the protocol in four main fields namely; religious, existence, emotional and social over 5 sessions before chemotherapy. The participants in the control group had received usual cares. Data were collected using Snyder's Hope Scale and Ellison's Scale Spiritual Well-Being Scale on a week before and after intervention. RESULTS: The total mean scores of the scales of hope and spiritual well-being in both groups did not present statistical differences in the pre-intervention assessment. In contrast, at the post assessment, significant differences (p<0.001) were found in the mean scores between the intervention and control groups on the hope scale (60.9 versus 39.8) and on the spiritual well-being scale (94.3 versus 71.6). CONCLUSIONS: Spiritual intervention could promote hope and spiritual well-being of persons with cancer.


Assuntos
Neoplasias , Espiritualidade , Humanos , Irã (Geográfico) , Neoplasias/terapia
18.
BMC Palliat Care ; 20(1): 181, 2021 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-34823512

RESUMO

BACKGROUNDS: Early integration of palliative care for terminally ill non-cancer patients improves quality of life. However, there are scanty data on Palliative Care Consultation Service (PCCS) among non-cancer patients. METHODS: In this 9-year observational study Data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill non-cancer patients with 9 categories of diagnoses who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in categories of diagnosis throughout study period, duration of PCCS, patient outcomes, DNR declaration, awareness of disease by patients and families before and after PCCS. RESULTS: In total, 536 non-cancer patients received PCCS from 2011 to 2019 with an average age of 70.7 years. The average duration of PCCS was 18.4 days. The distributions of age, gender, patient outcomes, family's awareness of disease before PCCS, and patient's awareness of disease after PCCS were significantly different among the diagnoses. Organic brain disease and Chronic kidney disease (CKD) were the most prevalent diagnoses in patients receiving PCCS in 2019. For DNR declaration, the percentage of patients signing DNR before PCCS remained high throughout the study period (92.8% in 2019). Patient outcomes varied according to the disease diagnoses. CONCLUSION: This 9-year observational study showed that the trend of PCCS among non-cancer patients had changed over the duration of the study. An increasing number of terminally ill non-cancer patients received PCCS during late life, thereby increasing the awareness of disease for both patients and families, which would tend to better prepare terminally ill patients for end-of-life as they may consider DNR consent. Early integration of PCCS into ordinary care for terminally non-cancer patients is essential for better quality of life.


Assuntos
Neoplasias , Cuidados Paliativos , Idoso , Humanos , Neoplasias/terapia , Qualidade de Vida , Encaminhamento e Consulta , Taiwan , Doente Terminal
19.
Ann Palliat Med ; 10(10): 10383-10390, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763484

RESUMO

BACKGROUND: The mortality of malignant tumors in rural areas of China in 2015 was significantly higher than that in city areas (213.6 per 100,000 vs. 191.5 per 100,000), bringing huge economic pressure to individuals and the local community. The comprehensive reform of county-level public hospitals in Yun County has helped patients with critical disease receive appropriate treatment. Therefore, an analysis focused on the epidemiology and disease burden of malignant tumors in Yun County could provide guidance for administrators and health practitioners in other counties. METHODS: This retrospective database study extracted data from the Yun County medical community (including two higher level hospitals: Yun County People's Hospital and Yun County Chinese Medicine Hospital, and 13 township central hospitals) from 1st Jul 2017 to 30th Aug 2020. Patients diagnosed as having a malignant tumor were enrolled and those with abnormal key baseline information were excluded. The epidemiology and disease burden for malignant tumor patients were assessed. RESULTS: A total of 3,792 patients were enrolled, and the most prevalent cancer in 2018 was thyroid (35.4 patients/100,000) and in 2019 this was lung cancer (30.6 patients/100,000). The mean outpatient visits per person for all-cause and tumor-specific visits were 9.99 and 3.94 visits across 2018 and 2019, respectively, and the mean inpatient visits per person in both years were the same at 2.56 visits. Total costs were 14.471 and 20.29 million in 2018 and 2019, respectively, and 71.7% and 73.0% of the total cost were covered by medical insurance over the 2 years. CONCLUSIONS: The medical environment has improved since medical system reform commenced in 2019 in Yun County, and medical insurance has decreased the disease burden for patients and their families significantly.


Assuntos
Efeitos Psicossociais da Doença , Neoplasias , China/epidemiologia , Demografia , Humanos , Neoplasias/epidemiologia , Neoplasias/terapia , Estudos Retrospectivos
20.
Praxis (Bern 1994) ; 110(15): 881-885, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34814713

RESUMO

Cachexia - A Cluster of Losses Abstract. Cachexia occurs in Cancer and other incurable diseases. Cachexia is regularly underdiagnosed and undertreated. The syndrome is defined by weight-loss, which is also caused by loss of muscle mass. The underlying cause is reason a systemic inflammation. It is associated with symptoms such as loss of appetite and is causing distress in patients and their families. Adequate staging and a multimodal therapy include treatment of the underlying disease, supportive measures and nutrition and exercise issues. At the end of life, symptom control and psychosocial support are most important.


Assuntos
Caquexia , Neoplasias , Caquexia/diagnóstico , Caquexia/etiologia , Caquexia/terapia , Terapia Combinada , Exercício Físico , Humanos , Neoplasias/complicações , Neoplasias/terapia , Perda de Peso
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