Incorporating palliative care principles to improve patient care and quality of life in urologic oncology.

Palliative care - specialized healthcare focused on improving quality of life for patients with serious illnesses - can help urologists to care for patients with unmet symptom, coping and communication needs. Society guidelines from the American Society of Clinical Oncology and the National Comprehensive Cancer Network recommend incorporating palliative care into standard oncological care, based on multiple randomized trials demonstrating that it significantly improves physical well-being, patient satisfaction and goal concordant care. Misconceptions regarding the objective and ideal timing of palliative care are common; a key concept is that palliative care and treatments seeking to cure or prolong life are not mutually exclusive. Urologists are well positioned to champion the integration of palliative care into surgical urologic oncology and should be aware of palliative care guidelines, indications for palliative care use and how the field of urologic oncology can adopt best practices.

Assessment of gait parameters and physical function in patients with advanced cancer participating in a 12-week exercise and nutrition programme: A controlled clinical trial.

OBJECTIVE: Gait is a sensitive marker for functional declines commonly seen in patients treated for advanced cancer. We tested the effect of a combined exercise and nutrition programme on gait parameters of advanced-stage cancer patients using a novel wearable gait analysis system. METHODS: Eighty patients were allocated to a control group with nutritional support or to an intervention group additionally receiving whole-body electromyostimulation (WB-EMS) training (2×/week). At baseline and after 12 weeks, physical function was assessed by a biosensor-based gait analysis during a six-minute walk test, a 30-s sit-to-stand test, a hand grip strength test, the Karnofsky Index and EORTC QLQ-C30 questionnaire. Body composition was measured by bioelectrical impedance analysis and inflammation by blood analysis. RESULTS: Final analysis included 41 patients (56.1% male; 60.0 ± 13.0 years). After 12 weeks, the WB-EMS group showed higher stride length, gait velocity (p < .05), six-minute walking distance (p < .01), bodyweight and skeletal muscle mass, and emotional functioning (p < .05) compared with controls. Correlations between changes in gait and in body composition, physical function and inflammation were detected. CONCLUSION: Whole-body electromyostimulation combined with nutrition may help to improve gait and functional status of cancer patients. Sensor-based mobile gait analysis objectively reflects patients' physical status and could support treatment decisions.

The epidemiology, diagnosis, and management of aristolochic acid nephropathy: a narrative review.

It has been 20 years since the first description of a rapidly progressive renal disease that is associated with the consumption of Chinese herbs containing aristolochic acid (AA) and is now termed aristolochic acid nephropathy (AAN). Recent data have shown that AA is also the primary causative agent in Balkan endemic nephropathy and associated urothelial cancer. Aristolochic acid nephropathy is associated with a high long-term risk for renal failure and urothelial cancer, and the potential worldwide population exposure is enormous. This evidence-based review of the diagnostic approach to and management of AAN draws on the authors' experience with the largest and longest-studied combined cohort of patients with this condition. It is hoped that a better understanding of the importance of this underrecognized and severe condition will improve epidemiologic, preventive, and therapeutic strategies to reduce the global burden of this disease.

Integrative medicine: complementary therapies and supplements.

Many patients with cancer or other urologic disorders use complementary therapies in an effort to control symptoms and to prevent and treat disease. Complementary modalities are adjuncts to mainstream treatment. These safe, evidence-based therapies reduce symptoms associated with treatment of urologic cancers and other illnesses. They are to be distinguished from 'alternative therapies', which are unproven, potentially harmful, and often promoted as substitutes for mainstream medical care. Accumulating evidence supports the beneficial impact of complementary therapies, such as acupuncture, yoga, meditation and physical activity, on physical and emotional symptoms associated with cancer treatment, for which there are few effective standard interventions. Herbs and other dietary supplements are unlikely to be beneficial, and might be problematic or dangerous when taken during cancer treatment.

[Pain therapy of urologic tumors -- prophylaxis and therapy of side effects]. / Schmerztherapie bei urologischen Tumoren -- Prophylaxe und Therapie der Nebenwirkungen.

Pain is a cardinal symptom in 70 % of cancer patients. Even in developed countries, 30 to 80 % of these patients are inadequately treated. The main cause for this lack of care is not pain refractory to treatment but inadequate or incorrect use of analgesic drugs. A sufficient treatment of pain requires knowledge of the pathomechanism of pain and of the basics of pain management in cancer patients. The choice of analgesic drugs follows the WHO-recommended increase based on need. As long as possible, analgesic drugs should be given orally following a strict schedule and pre-emptively prior to renewed pain. The non-opioids are a heterogeneous group of drugs with different actions and side effects. Maximum doses exist for this group and weak opioids. A change to strong opioids is indicated when weak opioids fail to achieve sufficient pain control despite titration to the maximum dose. No upper limit exists for strong opioids and their use is limited by the side effects. The most frequent side effects are initial emesis and vomiting as well as long-lasting constipation. For this reason, most patients should be prescribed a temporary antiemetic and a laxative on a permanent basis.

[Eight-MHZ RF hyperthermia in urological malignancies].

Eight-MHz radiofrequency hyperthermia (H) using Thermotron-RF8, and its combination with irradiation (RH), anticancer drugs (CH) or anticancer drugs plus irradiation (CRH), were carried out for a total of 93 urological malignancies: 19 cases of renal cancer, 3 of renal pelvic cancer, 4 of ureteral cancer 39 of bladder cancer, 8 of prostatic cancer, 14 of metastatic lesion of urological cancers and 6 of other urological cancers. All had failed in previous treatments, or had not undergone surgery because of their poor general condition. Nine cases, including 1 of renal cancer, 1 of ureteral cancer, 4 of bladder cancer, 2 of prostatic cancer and 1 of metastatic lesion of bladder cancer, were treated with (H). Fifty cases, including 4 renal cancer cases, 20 bladder cancer cases and 6 prostatic cancer cases, were treated with (RH). Eight of the 19 cases of renal cancer were treated with mitomycin C-microcapsule (MMC-mc) embolization prior to radiohyperthermia (CRH). The remaining 6 cases of renal cancer received embolization with MMC-mc followed by RE-heating (CH). Eighteen of the 48 cases of urothelial cancer or its metastasis, including 1 of renal pelvic cancer, 15 of bladder a cancer and 2 of metastatic lesion of bladder, received a combined treatment of intravenous THP-adriamycin, one of the derivatives of adriamycin and RE-heating (CH). In the remaining 2 cases, one received (CH), and the other received (CRH). Hyperthermia was given twice a week for a total of 10 sessions in 5 weeks. Intratumoral temperature was kept above 42.5 degrees C for 30 to 40 minutes during a one-hour heating. Complete tumor regression was obtained in 9 bladder cancer cases. Partial tumor regression, defined as a regression of 50% or more, was obtained in 17 cases. A pain relief was attained in 18 of 23 patients with intractable pain due to local tumor infiltration. As side effects, mild skin burns were observed in 21 cases. Ten obese cases, having subcutaneous tissue 15mm thick or more, developed fat tissue induration after treatment.