Exploración de los valores y deseos de pacientes con enfermedad crónica avanzada y con enfermedad crónica compleja. Conversaciones acerca del final de la vida / Reported wishes and values in patients with advanced chronic conditions (PACC) and patients with chronic condition (PCC). Conversations about end-of-life

OBJETIVO: Explorar los deseos y valores de los pacientes con Enfermedad Crónica Avanzada (MACA) y Enfermedad Crónica Compleja (PCC), usando el Go Wish Card Game (GWG) como instrumento para establecer una conversación sobre el final de la vida. MATERIAL Y MÉTODOS: Se incluyeron pacientes MACA y PCC ingresados en la unidad de convalecencia y larga estancia de la Fundació Sociosanitaria Santa Susanna. Se registraron datos sociodemográficos, nivel de instrucción, nivel de competencia mediante la Escala Móvil de Drane (EMD) y estado cognitivo mediante la escala de Pfeiffer. Se usó el GWG como instrumento para explorar los deseos y valores. Los pacientes seleccionaron entre las cartas lo importante y no importante. De las importantes, se les pidió que seleccionaran las 10 más importantes. Se evaluó la utilidad y adecuación de la entrevista. RESULTADOS: Se incluyeron 16 mujeres y 7 hombres, la edad promedio fue de 82,39 ± 7,38. MACA: 13 %; PCC: 87 %. El grado de instrucción fue: sin estudios: 56,5 %, estudios primarios: 43,5 %. Los niveles de competencia según la EMD fueron: I (8,7 %), II (52,2 %) y III (39,1 %). Pfeiffer = 2 errores: 60,8 %; entre 3-4 errores: 30,4 %; entre 5-7 errores: 8,6 %. Los deseos identificados como más importantes fueron: "No ser una carga para mi familia" (91,3 %), "No estar conectado a máquinas" (69,6 %) y "No tener dolor" (69,6 %). Los deseos menos importantes fueron: "Saber qué cambios puede tener mi cuerpo" (73,9 %); "Ser consciente de lo que está pasando" (65,2 %); y "Morir en casa" (65,2 %). La entrevista fue útil en el 91,3 % y apropiada en el 95,7 %. CONCLUSIÓN: No ser una carga para mi familia, no estar conectado a las máquinas y no tener dolor, fueron los deseos más importantes los pacientes MACA y PCC. El GWG fue un buen instrumento para explorar los deseos y valores acerca del final de la vida

OBJECTIVE: The aim was to explore wishes and values of Patients with Advanced Chronic Condition (PACC) and Chronic Condition (PCC), using the Go Wish Card Game (GWG) as a tool to establish a conversation about end-of-life (EOL). ATERIAL AND METHODS: PACC and PACC admitted to the in-patient unit of intermediate-care and long term-care of Fundació Sociosanitaria Santa Susanna were recruited. Sociodemographic data, level of education and competence level were recorded. Their competency was registered by Drane's sliding scale (DSS) and cognitive status using the Pfeiffer scale. We used the GWG as a tool to speak about EOL. Patients were asked to categorize these wishes as important or not important, which 10 wishes were most important, and to assess the usefulness and appropriate of the interview. RESULTS: 16 women and 7 men were recruited, the average age was 82.39 ± 7.38. PACC: 13 %, PCC: 87 %. The educational level was: without studies: 56.5 %, primary studies: 43.5 %. The DDS levels were: I (8.7 %), II (52.2 %) and III (39.1 %). Pfeiffer = 2 mistakes: 60.8 %; Between 3-4 mistakes: 30.4 %; Between 5-7 mistakes: 8.6 %. The desires identified as most important were: "Not being a burden for my family" (91.3 %), "Not connected to machines" (69.6 %) and "Not having pain" (69.6 %). The less frequent wishes were: "Knowing what changes my body can have" (73.9 %); "Be aware of what is happening" (65.2 %); And "Dying at home" (65.2 %). The interview was useful in 91.3 % and appropriate in 95.7 %. CONCLUSION: Not being a burden for my family, not being connected to machines and not having pain, were the most important wishes for the PACC and PCC. The GWG was a good tool to explore the desires and values about EOL

Evidence on the analgesic role of bisphosphonates and denosumab in the treatment of pain due to bone metastases: A systematic review within the European Association for Palliative Care guidelines project.

BACKGROUND: Bisphosphonates and denosumab are well-established therapies to reduce the frequency and severity of skeletal-related events in patients with bone metastasis. However, the analgesic effect of these medications on bone pain is uncertain. AIM: To identify, critically appraise and synthesize existing evidence to answer the following questions: 'In adult patients with metastatic bone pain, what is the evidence that bisphosphonates and denosumab are effective and safe in controlling pain?' and 'What is the most appropriate schedule of bisphosphonate/denosumab administration to control bone pain?'. This review also updates the 2002 Cochrane review 'Bisphosphonates for the relief of pain secondary to bone metastases'. DESIGN: Standard systematic review and narrative synthesis. DATA SOURCES: MEDLINE, EMBASE and Cochrane CENTRAL databases were searched for relevant articles published through 31 January 2014. A manual search was also performed. Study inclusion criteria were: a) conducted in adult patients; b) randomized controlled trial or meta-analisys; c) reported efficacy of bisphosphonates or denosumab on pain and/or decribed side effects versus placebo or other bisphosphonate; and d) English language. RESULTS: The database search yielded 1585 studies, of which 43 (enrolling 8595 and 7590 patients, respectively, in bisphosphonate and denosumab trials) met the inclusion criteria. Twenty-two (79%) of the 28 placebo-controlled trials found no analgesic benefit for bisphosphonates. None of the denosumab studies assessed direct pain relief. CONCLUSION: Evidence to support an analgesic role for bisphosphonates and denosumab is weak. Bisphosphonates and denosumab appear to be beneficial in preventing pain by delaying the onset of bone pain rather than by producing an analgesic effect per se.

Efficacy and Safety of Methadone as a Second-Line Opioid for Cancer Pain in an Outpatient Clinic: A Prospective Open-Label Study.

INTRODUCTION: Most clinical reports on methadone rotation describe outcomes in hospitalized patients. The few studies that have included outpatients are retrospective. The aim of this study was to assess the efficacy and safety of methadone as a second-line opioid in adult patients with advanced cancer after rotation in routine clinical practice at a palliative care outpatient clinic. PATIENTS AND METHODS: This was a prospective, open-label study of 145 patients whose treatment was rotated from other opioids to methadone. Informed consent was obtained in all cases. The main outcome measure was change in the variable "worst pain" at day 28. Pain and pain interference were assessed with the Brief Pain Inventory, with side effects evaluated according to the Common Terminology Criteria for Adverse Events version 3.0. Pain levels were evaluated at study entry and at days 3, 7, 9, 14, 21, and 28. RESULTS: Rotation to methadone was performed for the following reasons: poor pain control (77.9%), opioid side effects (2.1%), or both (20%). The mean daily oral morphine equivalent dose before rotation was 193.7 mg. The median worst and average pain scores decreased significantly (p < .0001) from baseline to day 28: The median worst pain score decreased from 9 (interquartile range [IQR]: 8-10) to 6 (IQR: 3-8), and the median average pain score decreased from 6 (IQR: 5-7) to 4 (IQR: 2-5). The proportions of patients with moderate to severe worst and average pain decreased by 30.3% and 47.5%, respectively, by day 28. No increase in opioid toxicity was observed during the study. CONCLUSION: In outpatients with advanced cancer, rotation to methadone as a second-line opioid was efficacious and safe when using a tiered scheme with close follow-up by experienced health professionals. IMPLICATIONS FOR PRACTICE: The results of this study, conducted prospectively under real clinical conditions, support the efficacy and safety of oral methadone as a second-line opioid in ambulatory patients with cancer. Moreover, these findings corroborate previously reported outcomes in retrospective outpatient studies and prospective studies that evaluated inpatient populations. Although more research into methadone rotation strategies is still needed, this study describes a successful tiered scheme of oral methadone rotation that was proven safe and effective during follow-up.

Enfermedad tromboembólica en el paciente oncológico avanzado: incidencia, complicaciones, tromboprofilaxis primaria y percepción del paciente / Thromboembolic disease in the advanced cancer patient: Incidence, complications, primary thrombo-prophylaxis and patient perception

JUSTIFICACIÓN: La enfermedad tromboembólica (ETE) venosa en el paciente avanzado es una complicación seria no siempre bien documentada. El objetivo principal es determinar la frecuencia de ETE en el paciente avanzado que ingresa en la Unidad de Agudos de Cuidados Paliativos. Los objetivos secundarios son analizar la frecuencia de tromboprofilaxis (TP) realizada durante la hospitalización, complicaciones asociadas y aceptación por parte del paciente. MATERIAL Y MÉTODOS: Estudio descriptivo prospectivo donde se recogieron datos sociodemográficos de los pacientes incluidos, factores de riesgo asociados a ETE, incidencia de la misma durante la hospitalización y a los 15 días postalta, y complicaciones asociadas con el tratamiento con heparina de bajo peso molecular (HBPM). El conocimiento de los pacientes sobre la TP y la satisfacción fueron evaluados mediante una escala simple ordinal. RESULTADOS: Entre marzo y junio de 2010 fueron incluidos 140 pacientes que ingresaron de forma consecutiva en la Unidad de Agudos de Cuidados Paliativos. Episodios de ETE ocurrieron en 10 pacientes (7,1%); en 4 de ellos (2,9%) fue la causa del ingreso y en 6 (4,3%) ocurrió durante la hospitalización o en los 15 días postalta. El tromboembolismo pulmonar fue más frecuente que la trombosis venosa profunda de miembros inferiores. Las complicaciones asociadas a la TP fueron menores (6% de sangrado y ningún caso de trombocitopenia). Se observó una mayor estancia media en el grupo de pacientes que desarrollaron ETE o fue la causa de ingreso (17,6 vs. 11,4 días; p < 0,05). Los objetivos de la TP primaria eran bien conocidos para el 30% de los pacientes. La mayoría (92%) afirmaron que la administración subcutánea de HBPM no ocasionó malestar. CONCLUSIONES: La frecuencia de ETE durante la hospitalización es relativamente baja pero asociada a mayor número de complicaciones y estancia prolongada. Los efectos secundarios asociados al empleo de HBPM fueron poco frecuentes y leves. La aceptación de la profilaxis fue muy buena (92%) a pesar de que el conocimiento preciso de su indicación fue bajo (30%). Son necesarios estudios controlados, aleatorizados para evitar factores de confusión y poder extraer conclusiones definitivas

BACKGROUND: Venous thromboembolic (VTD) disease in advanced cancer patients is a serious, not always well documented, complication. Primary aim: to determine the frequency of VTD in advanced cancer patients admitted to an Acute Palliative Care Unit. Secondary aim: to assess the thromboprophylaxis (TP) used during hospitalisation, the associated complications, and patient acceptance of TP. METHODS: The following variables were recorded in this descriptive prospective study of advanced cancer patients: socio-demographic data, risk factors of VTD, occurrence of VTD on/during hospitalisation and at 15 days post-discharge from hospital, and complications associated with the use of low molecular weight heparin (LMWH). Patient awareness and satisfaction with primary TP was evaluated using an ordinal scale questionnaire. RESULTS: Between March and June 2010, 140 consecutive patients were enrolled. VTD was noted in 10 patients (7.1%); in 4 (2.9%) it was the reason for admission, and in 6 (4.3%) it occurred during admission or 15 days after discharge. Pulmonary thromboembolism was more frequent than deep vein thrombosis. Complications associated with TP were minor (6% bleeding and no thrombocytopenia). A higher mean stay (17.6 vs. 11.4 days; P < .05) was observed in the VTD group. The aims of TP were well known to 30% of patients. The majority of patients (92%) noted that subcutaneous LMWH administration did not cause discomfort. CONCLUSIONS: The frequency of VTD in advanced cancer patients admitted to a Palliative Care Unit is low, but associated to a longer stay and complications. Adverse effects related to the use of heparin were few, and mild. There was very good patient acceptance (92%) of subcutaneous LMWH use, despite the low awareness of TP (30%). Further randomised studies are necessary to avoid confounding factors and to draw a definitive conclusion

Herramientas de educación sanitaria de fentanilo intranasal con pectina / Health education tools for the use of fentanyl pectin nasal spray

Una correcta educación sanitaria es esencial para el abordaje satisfactorio y el tratamiento del dolor. En los últimos años se han ido precisando tanto las características clínicas como los criterios diagnósticos del dolor irruptivo oncológico; han ido apareciendo en el mercado distintas formas galénicas de fentanilo y han sido abundantes los estudios clínicos sobre la eficacia y seguridad de estas formas de fentanilo para el tratamiento de los episodios de dolor irruptivo oncológico. El denominador común a la mayoría de estos estudios es la ausencia de relación entre la dosis eficaz de fentanilo que controla el dolor en crisis y la dosis del opioide basal, por lo que debe realizarse siempre una titulación individualizada. La titulación del fentanilo en cualquiera de sus formas galénicas (transmucosa nasal/oral) se convierte, por tanto, en un proceso que requiere de la monitorización estrecha de analgesia y efectos secundarios con cada dosis administrada. La educación sanitaria al paciente y la familia sobre el uso de opioides de liberación rápida se convierte en un aspecto clave de su éxito. En este capítulo se describen las herramientas de educación sanitaria que en el Servicio de Cuidados Paliativos del Institut Català d’Oncologia se han desarrollado para facilitar la comprensión de los episodios de dolor irruptivo oncológico y la correcta utilización de los fentanilos transmucosos

Proper health education is essential for the successful management and treatment of pain. In recent years, there has been a clarification of both the clinical features and diagnostic criteria of breakthrough cancer pain (BTcP), producing a new generation of drugs (fentanyl) with transmucosal absorption. Multiple clinical trials have been conducted on the safety and efficacy of these fentanyl preparations for the treatment of BTcP. The common denominator in most of these studies is the lack of relationship between the effective dose of fentanyl that controls pain exacerbations and the around-the-clock opioid dose, and therefore individualized titration should always be performed. Titration of fentanyl in any of its forms (transmucosal nasal/oral) therefore requires close monitoring of analgesia and adverse effects with each dose administered. Health education in patients and their families on the use of rapid-release opioids is a key aspect of their success. In this article, we describe the health education tools that have been developed by the palliative care service of the Catalan Institut of Oncology to facilitate the understanding of the use and titration of these drugs

Numb chin syndrome o neuropatía del nervio mentoniano como primera manifestación de progresión tumoral / Numb chin syndrome

La neuropatía mentoniana o síndrome de Roger es una neuropatía sensitiva que en muchas ocasiones se asocia a una neoplasia subyacente. Presentamos el caso de un paciente cuya progresión tumoral se manifestó en forma de neuropatía mentoniana secundaria a metástasis mandibular

Numb chin or Roger syndrome is a sensory neuropathy that is often associated with an underlying malignancy. We report a case of a patient whose tumor progression manifested as mental neuropathy secondary to mandibular metastasis

Utilidad y satisfacción de los pacientes de un instrumento educacional en dolor irruptivo oncológico: resultados preliminares / Usefulness and patient satisfaction with an educational tool on breakthrough cancer pain: preliminary results

JUSTIFICACIÓN: El dolor oncológico irruptivo se define como una exacerbación transitoria de dolor que aparece con un dolor basal adecuadamente controlado. Una nueva generación de fármacos (fentanilo) de absorción transmucosa mimetizan las características del dolor irruptivo, proporcionando un perfil analgésico ideal. Una correcta educación del paciente sobre las características del dolor y el modo de titulación de estos fármacos es esencial para un abordaje satisfactorio. OBJETIVO: Evaluar el grado de comprensión y utilidad que los pacientes otorgan a una hoja de información y soporte a la titulación (HIT) creada para facilitar la comprensión del empleo y titulación del fentanilo nasal en pectina. MATERIAL Y MÉTODO: Inclusión consecutiva de pacientes que ya habían completado el proceso de titulación y a los que se les había entregado la hoja informativa (HIT) para evaluar mediante encuesta su grado de comprensión y satisfacción. RESULTADOS: De los 20 pacientes incluidos, 2 no la habían utilizado como material de consulta. De los restantes, todos la consultaron al menos en una ocasión, el 85% la consideró muy útil y el 80% muy comprensible. El 33% sugirió modificaciones menores

JUSTIFICATION: Breakthrough cancer pain is defined as a transitory exacerbation of pain experienced by the patient who has relatively stable and adequately controlled baseline pain. Anew generation of drugs (fentanyl) with transmucosal absorption mimic the characteristics of breakthrough pain by providing an ideal analgesic profile. Good patient education on pain characteristics and the mode of titration of these drugs is essential for a successful approach. OBJECTIVE: To evaluate the degree of understanding and usefulness that patients given to a titration sheet created to facilitate the use and titration of nasal fentanyl pectin. METHODS: Twenty consecutive patients who had completed the titration and had received the titration sheet were included. A survey was used to assess their satisfaction. RESULTS: Of the 20 patients enrolled, 2 had not consulted the titration sheet because they were happy enough with the verbal instructions given. Of the rest, all had consulted it at least once, 85% considered it very useful and 80% very understandable and 33% suggested minormodifications

Health resource utilisation associated with skeletal-related events in European patients with lung cancer: Α subgroup analysis from a prospective multinational study.

Bone complications or skeletal-related events (SREs), typically defined as radiation to bone, pathological fractures, surgery to bone and spinal cord compression, occur frequently in patients with bone metastases. As the survival of patients with advanced lung cancer improves, preventing SREs is becoming increasingly clinically relevant. The aim of this analysis was to assess the impact of SREs on health resource utilisation (HRU) in European lung cancer patients with bone metastasis. This multinational, observational study included patients who had at least one SRE in the 97 days prior to enrolment, a life expectancy of ≥6 months and an Eastern Cooperative Oncology Group performance status of 0-2. Data on HRU were retrospectively collected for up to 97 days prior to enrolment with a planned prospective follow-up for up to 18-21 months. The HRU measures included the number and length of inpatient hospitalisations and the number of outpatient visits and procedures. The investigators determined whether each HRU was attributable to a SRE. In total, 135 patients with lung cancer, enrolled at centres in Germany, Italy, Spain and the United Kingdom, contributed 214 SREs to this analysis. The median length [quartile (Q)1, Q3] of follow-up ranged from 1.5 (0.7, 3.3) to 5.6 (2.0, 8.2) months across the countries. Overall, 41% of the SREs required an inpatient stay, with a median (Q1, Q3) duration of 19.0 (6.0, 28.0) days. Spinal cord compression and surgery to bone were the SRE types most frequently requiring inpatient stays. Radiation to bone was associated with the largest number of outpatient visits and procedures. All the SREs resulting from bone metastases in patients with lung cancer contribute considerably to HRU and efforts to minimise the incidence of bone complications in these patients through appropriate treatments may help reduce this burden.

Health resource utilization associated with skeletal-related events in patients with advanced breast cancer: results from a prospective, multinational observational study.

Patients with breast cancer and bone metastases often experience skeletal complications (skeletal-related events [SREs]: pathologic fracture, radiation to bone, surgery to bone or spinal cord compression). Prospective data on the health resource burden of SREs are needed for planning healthcare requirements and estimating the value of new treatments, but limited data are available. This prospective, observational study collected health resource utilization (HRU) data independently attributed to SREs by investigators. Eligible patients had bone metastases secondary to breast cancer, life expectancy ≥6 months, Eastern Cooperative Oncology Group (ECOG) performance status ≤2, and at least one SRE in the 97 days before enrollment. Data, collected retrospectively for 97 days before enrollment and prospectively for 18-21 months, included number and duration of inpatient stays, outpatient visits, emergency room visits and procedures. Altogether, 223 patients were enrolled from Germany, Italy, Spain and the UK. Of the 457 SREs, 118 (25.8%) were associated with inpatient stays. The mean duration of stay was 19.5 (standard deviation [SD] 19.2) days per SRE (based on 117 SREs). Surgery to bone and spinal cord compression were the SREs most likely to require inpatient stays (77.8% and 57.9% of SREs, respectively), while radiation to bone was the least likely (9.7%). Spinal cord compression required the longest inpatient stay per event (34.2 [SD 30.2] days) and radiation to bone the shortest (14.3 [SD 10.2] days). Overall, 342 SREs (74.8%) required an outpatient visit, with radiation to bone the most likely (85.7%), and surgery to bone the least likely (42.6%). Radiation to bone was also associated with the greatest number of outpatient visits per event (6.8 [SD 6.7] visits). All SREs were associated with substantial HRU therefore, preventing SREs in patients with breast cancer may reduce the burden imposed on healthcare systems.

Health Resource Utilization Associated with Skeletal-Related Events in Patients with Advanced Prostate Cancer: A European Subgroup Analysis from an Observational, Multinational Study.

This study aimed to increase the understanding of health resource utilization (HRU) associated with skeletal-related events (SREs) occurring in patients with bone metastases secondary to advanced prostate cancer. A total of 120 patients from Germany, Italy, Spain and the United Kingdom were enrolled in this observational study. They had bone metastases secondary to prostate cancer and had experienced at least one SRE in the 97 days before giving informed consent. HRU data were collected retrospectively for 97 days before enrolment and prospectively for up to 18-21 months. HRU, including the number and duration of inpatient hospitalizations, number of outpatient and emergency department visits and procedures, was independently attributed by investigators to an SRE. Of the 222 SREs included in this analysis, 26% were associated with inpatient stays and the mean duration per SRE was 21.4 days (standard deviation (SD) 17.8 days). Overall, 174 SREs (78%) required an outpatient visit and the mean number of visits per SRE was 4.6 (SD 4.6). All SREs are associated with substantial HRU. Preventing SREs in patients with advanced prostate cancer and bone metastases may help to reduce the burden to both patients and European healthcare systems.

Cancer-related neuropathic pain in out-patient oncology clinics: a European survey.

BACKGROUND: Although pain is frequently experienced by patients with cancer, it remains under-treated. The primary aim of this study was to estimate the prevalence of cancer-related neuropathic pain (CRNP) in patients with chronic pain who attended an outpatient clinic for standard care in Europe (irrespective of the reason or stage of the cancer). The secondary aims of this study were to characterise pain and cancer in patients with CRNP (including treatment) and to evaluate the usefulness of the painDETECT (PD-Q) screening tool to help physicians identify a potential neuropathic component of cancer-related pain. METHODS: An observational, non-interventional, cross-sectional, multi-centre study of adult patients with cancer using patient and physician case report forms (CRFs). Patients with CRNP were identified by physicians' clinical assessments after examining the completed PD-Q. RESULTS: A total of 951 patients visiting outpatient clinics across Europe were enrolled in this study between August 2010 and July 2011. Of these, 310 patients (32.60%; 95% confidence interval 29.62, 35.58) were identified as having CRNP. Twenty-nine of 39 (74.4%) physicians who completed the CRF relating to the PD-Q considered it a useful tool to help detect CRNP in daily practice and 28 of 39 (71.8%) indicated that they would use this tool in the future for most or some of their patients. Data from physicians before and after review of the completed PD-Qs showed a shift in clinical opinion (either to positive CRNP diagnosis [yes] or negative CRNP diagnosis [no]) in respect of 142 patients; about half of which (74) were categorised with an initial diagnosis of unknown. Opinions also shifted from a no to a yes diagnosis in 10 patients and from a yes to a no diagnosis in 51 patients. CONCLUSIONS: Approximately one-third of adults with cancer experiencing chronic pain attending outpatient clinics as part of routine care were considered to have CRNP in the opinion of the physicians after considering scores on the PD-Q. While physicians did not consider the PD-Q to be a useful tool for all patients, shifts in diagnosis before and after the use of this tool indicate that it may help physicians identify CRNP, especially where there is initial uncertainty.

Lidocaine 5 % patches as an effective short-term co-analgesic in cancer pain. Preliminary results.

PURPOSE: To analyze the short-term efficacy and patients' subjective perception of the use of lidocaine 5 % patches for painful scars (post-thoracotomy and post-mastectomy) and pain caused by chest wall tumors. METHODS: This is a prospective, descriptive, non-controlled, non-randomized, open-label study of patients seen in the palliative care outpatient clinic. Demographic data, variables relating to the severity of the pain, and concomitant therapy both at the start and end of treatment, the need for interventional anesthetic techniques (IAT), patients' subjective perception and treatment-related side effects were all recorded. RESULTS: Twenty patients were included with a mean follow-up of 29.2 days. The treatment led to a statistically significant clinical improvement in pain severity. There was no clinically significant opioid dose escalation during the treatment period. Only three patients required IAT to relieve the pain. Sixty five percent of patients were very satisfied with the therapy. No systemic or local adverse events were reported. CONCLUSIONS: The addition of lidocaine 5 % patches is effective in the short term for the treatment of neuropathic cancer pain accompanied by allodynia, whether deriving from a painful scar or chest wall tumor. These findings need to be confirmed by randomized controlled trials with larger samples.

Neoplasias hematológicas y cuidados paliativos: revisión sistemática de la literatura / Haematological malignancies and palliative care: a systematic literature review

Objetivo: Revisión sistemática de la literatura sobre la intervención de Cuidados Paliativos en el paciente con cáncer hematológico avanzado. Material y método: Realizamos una revisión sistemática sobre los artículos en PubMed y Cochrane, desde el 1 de enero de 2001 al 1 de mayo de 2009, publicados en español y en inglés, usando como palabras claves: «Haematology, Palliative Care, Dying, Death, Supporting Team, advanced Malignancies, Prognostic», así como literatura no indexada en páginas web y libros de Hematología y Cuidados Paliativos sobre temas relacionados. Se incluyeron artículos en cuyos abstracts incluyeran la información sobre la intervención de Cuidados Paliativos en el paciente con enfermedad hematológica maligna avanzada. Los artículos que solo trataban de tratamientos del tumor o de su pronóstico fueron excluidos. Resultados: Un total de 16 artículos fueron aceptados para su lectura y revisión. Se pueden diferenciar dos tipos de artículos: un grupo que hace referencia a las características clínicas de los pacientes y, un segundo grupo que hace referencia a las experiencias de profesionales, pacientes y familiares al final de la vida. Conclusiones: De la información obtenida de la revisión se constata una escasa y heterogénea información al respecto, surgiendo la necesidad de ampliar el estudio en pacientes y familiares en fases avanzadas de la enfermedad hematológica maligna (AU)

Objective: To conduct a systematic review of the literature on the palliative care intervention in the far-advanced patient with haematological malignancies. Material and method: We carried out a systematic search of articles in PubMed and Cochrane, from 1 January 2001 to 1t May 2009, published in Spanish or English, and using ‘‘Haematology, Palliative Care, Dying, Death, Supporting Team, advanced Malignancies, Prognosis’’. Websites and Palliative and Haematology journals and books were also searched. We included papers with an abstract providing information of palliative care intervention in patients with far advanced haematological malignancies. Papers dealing with tumour treatment or prognosis were excluded. Results: Sixteen papers were acceptable for full reading and assessment. Two categories of works could be differentiated; one regarding the clinical characteristics of the patients, and a second lot of papers devoted to the professional, and patient/families experiences with the disease at the end of life. Conclusions: Information provided by the review gave us little and heterogeneous information. Thus there is a great need for the patients and families living with the last stages of haematological malignancy. Further studies are needed (AU)