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1.
Medicine (Baltimore) ; 99(7): e19258, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049866

RESUMO

Primary tumor resection (PTR) for unresectable metastatic colorectal cancer (mCRC) patients has been documented to be associated with postoperative hyper-neovascularization and enhanced growth of metastases, which may be prevented by bevacizumab. This study aimed to investigate the survival outcome of PTR in patients who received palliative bevacizumab-containing chemotherapy (BCT).From January 2006 to December 2018, medical records of 240 mCRC patients who received palliative BCT at a single tertiary colorectal cancer center were retrospectively reviewed. Patients were classified into three groups: PTR-a (PTR before BCT, n = 60), PTR-b (PTR during BCT, n = 17), and BCT-only group (n = 163). Resectable mCRCs or recurrent diseases were excluded, and the end-point was overall survival (OS) rate.Three groups had similar age, cell differentiation, location of the primary tumor, and the number of metastatic organs. More than two-thirds of patients who received PTR experienced disease-progressions (PD) during their postoperative chemotherapy-free time (PTR-a vs PTR-b; 66.7% vs 76.5%, P = .170), but OS was not inferior to the BCT-only group (PTR-a vs BCT-only; HR 0.477 [95% CI 0.302-0.754], P = .002/PTR-b vs BCT-only; HR 0.77 [95% CI 0.406-1.462], P = .425). The postoperative chemotherapy-free time was similar between PTR-a and PTR-b (median 32.0 [14-98] days vs 41.0 [18-71] days, P = .142), but non-obstructive indications (perforation, bleeding, pain) were the more frequent in the PTR-b than PTR-a. Young age, the number of BCT, and PTR-a were the independent factors for OS.The efficacy of the PTR for unresectable mCRC has been controversial, but this study demonstrated that PTR should be considered for the unresectable mCRC patients regardless before and during BCT.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Bevacizumab/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Cuidados Paliativos , República da Coreia/epidemiologia , Estudos Retrospectivos
2.
4.
Anticancer Res ; 40(2): 965-975, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014941

RESUMO

BACKGROUND/AIM: A standard treatment recommendation for advanced stage gastroesophageal cancer is still missing. PATIENTS AND METHODS: We retrospectively analyzed clinical data of patients with inoperable locally advanced or metastatic gastroesophageal cancer treated between 2001 and 2017 at the Vienna General Hospital, Austria. RESULTS: Administration of systemic therapy was positively associated with overall survival (OS) (469 days vs. 185 days; p<0.001), while palliative gastrectomy or radiotherapy showed no correlation. OS was significantly longer in patients receiving capecitabine/oxaliplatin (XELOX) vs. leucovorin/5-FU/oxaliplatin (FOLFOX) (600 days vs. 327 days, p<0.05). Comparison of doublet vs. triplet chemotherapies showed no difference in OS, but triplet chemotherapy resulted in more adverse events. The anti-HER2-antibody trastuzumab doubled OS (836 days vs. 399 days, p=0.053). CONCLUSION: Capecitabine may be preferably used over infused 5-FU and doublet chemotherapy over triplet chemotherapy in the first-line palliative setting of advanced gastroesophageal cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Cuidados Paliativos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Esofágicas/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Cuidados Paliativos/métodos , Neoplasias Gástricas/mortalidade , Resultado do Tratamento
9.
Artigo em Alemão | MEDLINE | ID: mdl-31968387

RESUMO

Patients with palliative diseases often suffer from a variety of onerous symptoms with marked impairment in quality of life. The treatment is often difficult. One reason is that patients usually have several problems at the same time. Another reason is that the need for medication can cause additional side effects, which in turn have to be treated as well. In this article we explain most of these symptoms and give treatment recommendations based on the current literature (excluding pain therapy). In particular, this article is divided into the following sub-items: mucositis/stomatitis, dyspnea, nausea, constipation, anxiety, depression, weakness/fatigue, delirium, sleep disorders and terminal restlessness, pruritus, pleural effusion, ascites. Most palliative patients need individualized treatment. Sometimes medication has to be used in an off-label way, and sometimes one must just hold a hand and be there for the patient or their relatives. The most important principle in working with palliative care patients is to maintain or restore quality of life. Our therapy should always be adapted to the needs of the patient and the most important goal is to preserve our patients' autonomy.


Assuntos
Neoplasias , Cuidados Paliativos , Assistência Terminal , Ansiedade , Depressão , Dispneia , Humanos , Náusea , Neoplasias/terapia , Qualidade de Vida
10.
Artigo em Alemão | MEDLINE | ID: mdl-31968388

RESUMO

One third of oncological treatment costs per patient is allocated to the last phase of life. In the era of molecular oncology and immuno-oncology, patients benefit from new treatment options inducing durable and long-lasting responses. However, it becomes more difficult to estimate the prognosis of oncology patients. The treatment indication is based on the evidence from randomized controlled studies. In contrast, the decision, when to stop treatment at the end of life and provide best supportive care, is an emerging and challenging situation in routine clinical care of oncologists and palliative care teams. Up to 50% of oncology patients receive chemotherapy within the last 4 weeks before death, thus it becomes evident to stop futile treatment. Reliable biomarkers to predict the response of immunotherapy are lacking for most of solid tumors. Several palliative prognostic scores have been validated to calculate the probability of survival in the next 30 - 60 days. Unfortunately, there is no consensus on which score should be preferred and none was validated in period of immuno-oncology. The estimation of expectation of life by an interdisciplinary medical team is recommended by the German guideline of palliative medicine. Of note, treating physicians often overestimate the prognosis of patients, and shared decision making whether to start, to continue or to stop therapy for the individual patient remains difficult. Early integration of palliative medicine and advance care planning focus on the patient's medical perspective. Clinical trials investigating the integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Changes at the system level are necessary for implementation of advance care planning to improve the quality of the end of life of oncology patients.


Assuntos
Neoplasias , Cuidados Paliativos , Qualidade de Vida , Assistência Terminal , Humanos , Oncologia , Neoplasias/terapia
11.
Artigo em Alemão | MEDLINE | ID: mdl-31968389

RESUMO

Palliative care is becoming increasingly important in intensive care units. The main goal of palliative treatment is to improve quality of life in patients with critical and life-threatening conditions when curative therapies can no longer be achieved. Treatment is not limited to end-of-life care, but also includes relief of distressing symptoms such as pain, nausea, vomiting, dyspnea, delirium or anxiety, as well as communication with patients and their families. Defining patient-centred goals of care together with patients, relatives and intensive care staff supports shared decision-making. Aspects of palliative care can be integrated in the ICU in different ways. The "integrative model" presumes that all patients with critical illness may benefit from palliative care principles and interventions practiced by the ICU team. The "consultative model" involves palliative care consultants in the care of ICU patients with palliative care need that may be identified using trigger criteria. This article gives an overview on different aspects of palliative care in intensive care units and provides practical advice for the implementation of palliative care in the ICU.


Assuntos
Unidades de Terapia Intensiva , Cuidados Paliativos , Assistência Terminal , Cuidados Críticos , Humanos , Qualidade de Vida
13.
Rev Esp Cardiol (Engl Ed) ; 73(1): 69-77, 2020 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31761573

RESUMO

Heart failure is a complex entity, with high morbidity and mortality. The clinical course and outcome are uncertain and difficult to predict. This document, instigated by the Heart Failure and Geriatric Cardiology Working Groups of the Spanish Society of Cardiology, addresses various aspects related to palliative care, where most cardiovascular disease will eventually converge. The document also establishes a consensus and a series of recommendations with the aim of recognizing and understanding the need to implement and progressively apply palliative care throughout the course of the disease, not only in the advanced stages, thus improving the care provided and quality of life. The purpose is to improve and adapt treatment to the needs and wishes of each patient, who must have adequate information and participate in decision-making.


Assuntos
Cardiologia , Consenso , Insuficiência Cardíaca/terapia , Cuidados Paliativos/normas , Sociedades Médicas , Idoso , Tomada de Decisões , Humanos , Espanha
15.
Rev Esp Cardiol (Engl Ed) ; 73(1): 78-83, 2020 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31611151

RESUMO

Heart failure (HF) is a progressive condition with high mortality and heavy symptom burden. Despite guideline recommendations, cardiologists refer to palliative care at rates much lower than other specialties and very late in the course of the disease, often in the final 3 days of life. One reason for delayed referral is that prognostication is challenging in patients with HF, making it unclear when and how the limited resources of specialist palliative care will be most beneficial. It might be more prudent to consider palliative care referrals at critical moments in the trajectory of patients with HF. These include: a) the development of poor prognostic signs in the outpatient setting; b) hospitalization or intensive care unit admission, and c) at the time of evaluation for certain procedures, such as left ventricular assist device placement and ablation for refractory ventricular arrhythmias, among others. In this review, we also summarize the results of clinical trials evaluating palliative interventions in these settings.


Assuntos
Insuficiência Cardíaca/terapia , Cuidados Paliativos/métodos , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/normas , Humanos
16.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 281-290, jan.-dez. 2020. ilus
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047745

RESUMO

Objetivo: identificar quais diagnósticos de enfermagem da taxonomia da North American Nursing Diagnosis Association Internacional (NANDA-I) descritos ou indicados nas produções científicas possuem relação com os pacientes em cuidados paliativos e quais são as intervenções de enfermagem mais adequadas segundo a Classificação das Intervenções de Enfermagem (NIC). Método: revisão integrativa da literatura, que consiste na construção de uma análise ampla da literatura tendo como propósito inicial obter entendimento de um determinado fenômeno baseando-se em estudos anteriores. Resultados: realizou-se um levantamento sobre os estudos relacionados ao tema em fontes bibliográficas através de três sistemas informatizados. Dos artigos encontrados, apenas dez tornavam possível a identificação de Diagnósticos de Enfermagem, ou sua inferência. Estes diagnósticos foram contabilizados e relacionados às intervenções mais adequadas de acordo com a literatura. Conclusão: foi identificada uma produção científica pouco expressiva, mas, ainda assim, foi possível identificar diagnósticos e inferências diagnósticas que permitiram determinar quais intervenções de enfermagem seriam as mais adequadas


Objective: to identify which nursing diagnoses of the North American Nursing Diagnosis Association Internacional (NANDA-I) taxonomy described or indicated in the scientific productions are related to patients in palliative care and which are the most appropriate nursing interventions according to the Nursing Interventions Classification (NIC). Method: an integrative review of the literature, which consists of the construction of a comprehensive literature review, with the initial purpose of obtaining an understanding of a given phenomenon based on previous studies. Results: a survey of the studies related to the subject was carried out in bibliographic sources through three computerized systems. Of the articles found, only ten made possible the identification of Nursing Diagnostics, or their inference. These diagnoses were counted and related to the most appropriate interventions according to the literature. Conclusion: little expressive scientific production was identified, but it was still possible to identify diagnoses and diagnostic inferences that allowed to determine which nursing interventions would be the most adequate


Objetivo: identificar qué diagnósticos de enfermería de la taxonomía de la North American Nursing Diagnosis Association Internacional (NANDA-I) descritos o indicados en las producciones científicas, poseen relación con los pacientes en cuidados paliativos y cuáles son las intervenciones de enfermería más adecuadas según la Clasificación de las intervenciones en enfermería (NIC). Método: revisión integrativa de la literatura, que consiste en la construcción de un análisis amplio de la literatura teniendo como propósito inicial obtener entendimiento de un determinado fenómeno basándose en estudios anteriores. Resultados: se realizó un relevamiento sobre los estudios relacionados al tema en fuentes bibliográficas a través de tres sistemas informatizados. De los artículos encontrados, sólo diez hicieron posible la identificación de Diagnósticos de Enfermería, o su inferencia. Estos diagnósticos fueron contabilizados y relacionados con las Intervenciones más adecuadas de acuerdo con la literatura. Conclusión: se identificó una producción científica poco expresiva, pero aún así fue posible identificar diagnósticos e inferencias diagnósticas que permitieron determinar qué intervenciones de enfermería serían las más adecuadas


Assuntos
Humanos , Masculino , Feminino , Cuidados Paliativos/classificação , Diagnóstico de Enfermagem/classificação , Terminologia Padronizada em Enfermagem
17.
Int J Radiat Oncol Biol Phys ; 106(1): 61-66, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31505246

RESUMO

PURPOSE: To evaluate the use of single-fraction palliative radiation therapy (SFRT) for the management of bone metastases (BM) in Victoria, Australia. METHODS AND MATERIALS: This is a population-based cohort of patients with cancer who received radiation therapy for BM between 2012 and 2017 as captured in the Victorian Radiotherapy Minimum Data Set. The primary outcome was proportion of SFRT use. The Cochrane-Armitage test for trend was used to evaluate changes in practice over time. Multivariable logistic regression was used to assess factors associated with SFRT use. RESULTS: Of the 18,158 courses of radiation therapy for BM delivered to a total of 10,956 patients, 17% were SFRT. There was no significant change in SFRT use over time, from 18% in 2012 to 19% in 2017 (P = .07). SFRT was less commonly given to the skull (4%) and spine (14%), compared with the shoulder (37%) and ribs (53%). Patients with lung cancer (21%) were most likely to receive SFRT, followed by those with prostate cancers (18%) and gastrointestinal cancers (16%). Patients from regional/remote areas were more likely to have SFRT compared with those in major cities (22% vs 16%, P < .001). Patients treated in public institutions were more likely to have SFRT compared with those treated in private institutions (22% vs 10%, P < .001). In multivariable analyses, increasing age, lung cancer, higher socioeconomic status, residence in regional/ remote areas, and being treated in public institutions were factors independently associated with increased likelihood of receiving SFRT. CONCLUSIONS: SFRT appears underused for BM in Australia over time, with variation in practice by patient, tumor, sociodemographic, geographical, and institutional provider factors.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Cuidados Paliativos/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Austrália , Fracionamento da Dose de Radiação , Feminino , Neoplasias Gastrointestinais , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Neoplasias Pulmonares , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/estatística & dados numéricos , Neoplasias da Próstata , Radioterapia/métodos , Radioterapia/estatística & dados numéricos , Dosagem Radioterapêutica , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Fatores de Tempo , População Urbana/estatística & dados numéricos
18.
Int J Radiat Oncol Biol Phys ; 106(1): 67-72, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31622698

RESUMO

PURPOSE: Patients with locally advanced and metastatic esophageal cancer are usually affected by cancer-related symptoms, which worsen their performance status and quality of life. The aim of this study was to determine the efficacy of short-course accelerated radiation therapy for symptomatic palliation in a low resourced setting where only a 2-dimensional radiation therapy (RT) technique was available. METHODS AND MATERIALS: A phase II trial based on Simon's 2-stage design was planned. A total dose of 12 Gy in 4 fractions, twice per day, over 2 days, ≥8 hours apart, using a 2-dimensional conventional RT technique was delivered with a Cobalt 60 unit (Equinox, Best Theratronics, Ottawa, Ontario). Symptoms were graded using the International Atomic Energy Agency scoring system. RESULTS: A total of 17 patients were treated (male/female = 10/7; median age, 50.0 years; range, 27-78 years; histology: 6 adenocarcinomas and 11 squamous cell carcinomas; tumor site: 4 gastresophageal junction and 13 esophagus). The most frequent baseline symptoms were dysphagia or regurgitation (100%), odynophagia (76%), and chest or back pain (53%). At 1 month after RT, all patients were alive with palliative response rates (complete plus partial) for dysphagia, regurgitation, odynophagia, and chest or back pain of 76%, 82%, 69%, and 56%, respectively. No patients presented acute ≥G3 toxicity. CONCLUSIONS: Short-course accelerated radiation therapy treatment, planned and delivered using a conventional 2-dimensional RT technique, was effective and well tolerated for the symptomatic palliation of locally advanced or metastatic esophageal cancer. This schedule may be useful for RT centers in developing countries to reduce treatment times, costs, and patient waiting times before treatment.


Assuntos
Adenocarcinoma/radioterapia , Carcinoma de Células Escamosas/radioterapia , Neoplasias Esofágicas/radioterapia , Cuidados Paliativos/métodos , Adulto , Idoso , Transtornos de Deglutição/etiologia , Países em Desenvolvimento , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Junção Esofagogástrica , Etiópia , Feminino , Humanos , Avaliação de Estado de Karnofsky , Refluxo Laringofaríngeo/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Hipofracionamento da Dose de Radiação
19.
Zhonghua Wai Ke Za Zhi ; 57(12): 939-943, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826600

RESUMO

Objective: To examine the early- and midterm outcomes of pulmonary artery banding as an initial palliation in patients with single ventricle associated with unrestricted pulmonary blood flow. Methods: Between January 2008 and December 2017, 49 patients with single ventricle and unrestricted pulmonary blood flow underwent pulmonary artery banding at Department of Cardiac Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University. There were 29 males and 20 females. The age at the time of surgery was 5.6 (11.5) months (M(Q(R))), and the weight was 5.2 (3.9) kg. The medical records and results after pulmonary artery banding (death/reoperation, transition to the Glenn procedure) and subsequently after the Glenn procedure (death, transition to the Fontan procedure) were reviewed retrospectively. Actuarial survivals were estimated by the Kaplan-Meier curve. Relative factors for affecting outcomes were analyzed using the Cox regression hazard model. Results: There were 8 early deaths, with a mortality of 16.3%, including 4 cases who received simultaneous arch repair. There were 5 late deaths. During the follow-up of 47(62) (M(Q(R))) months, 11 patients (22.4%) underwent pulmonary artery banding adjustment, 29 patients (59.2%) underwent the Glenn procedure, 21 patients (42.8%) underwent the Fontan procedure. The survival of patients after the initial pulmonary artery banding were 77.4% (95%CI: 65.6% to 89.2%) and 72.6% (95%CI: 59.9% to 85.3%) at 1 year and 5 years, respectively. Multivariate Cox regression analysis revealed that systemic ventricular outflow tract obstruction (HR=4.25, 95%CI: 1.50 to 12.03, P=0.006) and total anomalous pulmonary venous connection (HR=6.49, 95%CI: 3.24 to 12.98, P=0.000) were relative factors for death. Conclusions: The early and midterm outcomes of pulmonary artery banding as an initial palliative strategy is not satisfactory. Systemic ventricular outflow tract obstruction and total anomalous pulmonary venous connection are associated with high mortality.


Assuntos
Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Cuidados Paliativos/métodos , Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Vasculares/mortalidade , Feminino , Seguimentos , Ventrículos do Coração/anormalidades , Humanos , Lactente , Recém-Nascido , Masculino , Circulação Pulmonar , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
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