RESUMO
OBJECTIVE: Fatigue is the most common and often the most bothersome complaint of individuals who are treated for cancer. One intervention now commonly suggested to treat fatigue is the use of psychostimulant medication. Early studies indicate some success in individuals with a mixed cancer diagnoses. This study evaluates the effect of methylphenidate on fatigue in women with recurrent gynecologic cancer. METHOD: Thirty-two women treated for recurrent gynecologic cancer were prescribed methylphenidate at morning and noon over a 8-week period. Participants completed the Fatigue Symptom Inventory (FSI) along with assessments of quality of life and mood at baseline, week 2, 4 and 8 to determine changes in levels of fatigue experienced. RESULTS: Patients reported significant declines in fatigue (p=0.0001), and improvement in both mood (p=0.0020) and quality of life (p=0.0351) when comparing baseline scores to study end. CONCLUSIONS: This study provides support for the use of a psychostimulant to treat fatigue in women who have recurrent gynecologic cancer. It is particularly relevant for these patients with incurable disease who are facing the end of life.
Assuntos
Estimulantes do Sistema Nervoso Central/uso terapêutico , Fadiga/tratamento farmacológico , Neoplasias dos Genitais Femininos/complicações , Metilfenidato/uso terapêutico , Adulto , Afeto , Idoso , Idoso de 80 Anos ou mais , Fadiga/etiologia , Fadiga/psicologia , Feminino , Neoplasias dos Genitais Femininos/tratamento farmacológico , Neoplasias dos Genitais Femininos/psicologia , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Projetos Piloto , Qualidade de Vida , Resultado do Tratamento , Adulto JovemRESUMO
Carcinomatous polyarthritis (CP) is a rare paraneoplastic disorder that has been associated with a variety of solid tumors. It presents in a similar manner to other polyarticular disorders and often precedes detection of the underlying malignancy, making recognition critical. CP responds to the treatment of the neoplastic process. We present a patient who initially presented with asymmetric inflammatory polyarthritis who was later diagnosed with bronchogenic carcinoma. Following the case report we present our learning objectives, which include the differential diagnosis of inflammatory polyarthritis, diagnostic approach to CP, and features that distinguish it from other more common causes of polyarthritis. We conclude with a brief discussion of the pathophysiology and management of CP.
Assuntos
Artrite/complicações , Artrite/diagnóstico , Síndromes Paraneoplásicas/complicações , Síndromes Paraneoplásicas/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , MasculinoRESUMO
Gemcitabine-associated thrombotic thrombocytopenic purpura (TTP) is a rare complication of gemcitabine treatment with a incidence ranging from 0.015% to 1.4%. Clinically, this disease manifests as haemolytic anaemia, thrombocytopenia, and renal insufficiency; hypertension and neurological and pulmonary symptoms are also known complications. The risk of TTP increases as the cumulative dose of gemcitabine approaches 20,000 mg/m(2). The pathophysiology of this disease entity is unknown although several theories, involving both immune and non-immune mechanisms, have been proposed. The most effective treatment is discontinuation of gemcitabine, the provision of antihypertensive medications as needed, and consideration of plasmapheresis or use of immunoadsorption column in severe cases.