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1.
Medicine (Baltimore) ; 100(27): e26616, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232219

RESUMO

ABSTRACT: There has been increased use of self-expandable metal stents (SEMS) in treating malignant colorectal obstruction (MCO). The aim of this study was to investigate factors that are associated with the outcomes of SEMS placement for MCO.Clinical data from patients who underwent SEMS placement for MCO at 6 hospitals in Honam province of South Korea between 2009 and 2018 were reviewed retrospectively. Eight hundred two patients were identified and their data were analyzed. Technical success, clinical success, complications, and predictors of outcome were included as main outcome measures.Technical and clinical success rates were 98.8% (792/802) and 90.1% (723/802), respectively. Complications including stent migration, stent occlusion due to tumor ingrowth and outgrowth, perforation, bacteremia/fever, and bleeding occurred in 123 (15.3%) patients. In multivariate regression analyses, procedure time was significantly associated with the technical success of SEMS placement (P = .001). Longer length of obstruction, the use of covered stent, and longer procedure time were significant independent predictive factors for the clinical success of SEMS placement (odds ratio [OR] 0.974 (95% confidence interval [CI] 0.950-0.990); P = .043, OR 0.255 (95% CI 0.138-0.471); P < .001, and OR 0.957 (95% CI 0.931-0.984); P = .002, respectively). Stage IV colorectal cancer and the use of covered stent were significant independent predictive factors for the development of complications after SEMS placement (OR 2.428 (95% CI 1.407-4.188); P = .001 and OR 3.329 (95% CI 2.060-5.378); P < .001, respectively).Longer length of obstruction, the use of covered stent, and longer procedure time were associated with lower clinical success rates. Having stage IV colorectal cancer and the use of covered stents were associated with an increased risk of complications.


Assuntos
Neoplasias Colorretais/complicações , Obstrução Intestinal/cirurgia , Cuidados Paliativos/métodos , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
Nutrients ; 13(5)2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-34066386

RESUMO

Nutritional management of patients under palliative care can lead to ethical issues, especially when Enteral Nutrition (EN) is prescribed by nasogastric tube (NGT). The aim of this review is to know the current status in the management of EN by NG tube in patients under palliative care, and its effect in their wellbeing and quality of life. The following databases were used: PubMed, Web of Science (WOS), Scopus, Scielo, Embase and Medline. After inclusion and exclusion criteria were applied, as well as different qualities screening, a total of three entries were used, published between 2015 and 2020. In total, 403 articles were identified initially, from which three were selected for this review. The use of NGT caused fewer diarrhea episodes and more restrictions than the group that did not use NG tubes. Furthermore, the use of tubes increased attendances to the emergency department, although there was no contrast between NGT and PEG devices. No statistical difference was found between use of tubes (NGT and PEG) or no use, with respect to the treatment of symptoms, level of comfort, and satisfaction at the end of life. Nevertheless, it improved hospital survival compared with other procedures, and differences were found in hospital stays in relation to the use of other probes or devices. Finally, there are not enough quality studies to provide evidence on improving the health status and quality of life of the use of EN through NGT in patients receiving palliative care. For this reason, decision making in this field must be carried out individually, weighing the benefits and damages that they can cause in the quality of life of the patients.


Assuntos
Nutrição Enteral/instrumentação , Intubação Gastrointestinal/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Adulto , Nutrição Enteral/ética , Nutrição Enteral/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Qualidade de Vida , Resultado do Tratamento
3.
Clin Adv Hematol Oncol ; 19(6): 390-395, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34106913

RESUMO

The provision of specialty palliative care alongside oncology care is now recommended by the American Society of Clinical Oncology (ASCO) on the basis of multiple randomized trials showing that it leads to better symptom control, less depression and anxiety, improved quality of life, improved caregiver quality of life, and even longer survival. That said, simply not enough palliative care specialists are available to provide concurrent care, so oncologists are tasked with providing the greatest part of primary palliative care. It is useful to think of primary palliative care as comprising 2 skill sets, or "bundles": the first symptom assessment and management, and the second communication. Symptom assessment begins with the use of a standardized scale that emphasizes the assessment of anxiety, depression, physical symptoms, and coping strategies. Communication requires knowing how much information the patient and family want, especially about prognosis, and involves shared decision making. It also encompasses advance care planning, starting with the identification of a medical power of attorney and proceeding to a discussion about hospice and end-of-life treatment choices. The communication skill set includes providing caregiver support and spiritual care referral, making culturally appropriate decisions, and providing a specific statement of non-abandonment near the end of life. If specialty palliative care is involved, data show that the effect on quality of life and end-of-life choices is most meaningful if consultation is started at least 3 months before death. In this article, we provide a brief overview of the benefits of incorporating palliative care into routine oncologic practice and offer clinical pearls on how best to deliver the tenets of palliative care in the outpatient and inpatient settings.


Assuntos
Neoplasias/terapia , Cuidados Paliativos/métodos , Humanos , Oncologia/métodos , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Qualidade de Vida , Avaliação de Sintomas
4.
Medicine (Baltimore) ; 100(18): e25841, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950997

RESUMO

ABSTRACT: Palliative care has improved quality of end-of-life (EOL) care for patients with cancer, and these benefits may be extended to patients with other serious illnesses. EOL care quality for patients with home-based care is a critical problem for health care providers. We compare EOL quality care between patients with advanced illnesses receiving home-based care with and without palliative services.The medical records of deceased patients who received home-based care at a community teaching hospital in south Taiwan from January to December 2019 were collected retrospectively. We analyzed EOL care quality indicators during the last month of life.A total of 164 patients were included for analysis. Fifty-two (31.7%) received palliative services (HP group), and 112 (68.3%) did not receive palliative services (non-HP group). Regarding the quality indicators of EOL care, we discovered that a lower percentage of the HP group died in a hospital than did that of the non-HP group (34.6% vs 62.5%, P = .001) through univariate analysis. We found that the HP group had lower scores on the aggressiveness of EOL care than did the non-HP group (0.5 ±â€Š0.9 vs 1.0 ±â€Š1.0, P<.001). Furthermore, palliative services were a significant and negative factor of dying in a hospital after adjustment (OR = 0.13, 95%CI = 0.05-0.36, P < .001).For patients with advanced illnesses receiving home-based care, palliative services are associated with lower scores on the aggressiveness of EOL care and a reduced probability of dying in a hospital.


Assuntos
Estado Terminal/terapia , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Cuidados Paliativos/organização & administração , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Assistência Terminal/organização & administração , Idoso , Idoso de 80 Anos ou mais , Estado Terminal/mortalidade , Feminino , Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Comunitários/organização & administração , Hospitais Comunitários/estatística & dados numéricos , Hospitais de Ensino/organização & administração , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Cuidados Paliativos/métodos , Cuidados Paliativos/estatística & dados numéricos , Estudos Retrospectivos , Taiwan/epidemiologia , Assistência Terminal/métodos , Assistência Terminal/estatística & dados numéricos
5.
Curr Opin Psychiatry ; 34(4): 357-362, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1228583

RESUMO

PURPOSE OF REVIEW: Opioid use is prevalent in the United Kingdom and prior to the COVID-19 pandemic it had been recognized that the safety of opioids was an important issue to be monitored by the UK medicines regulatory agency. With the emergence of COVID-19, this requirement has been even greater. This review was undertaken to determine the impact of the pandemic on safety and surveillance of opioids in the United Kingdom. RECENT FINDINGS: During the COVID-19 pandemic, the surveillance of opioids in the United Kingdom continued, although primary research was often conducted with data prior to the pandemic. Of those studies that were conducted while the pandemic was ongoing, access to opioids (or opioid substitution therapy) and the subsequent effect on patient safety was the main theme. SUMMARY: In the United Kingdom, changes in accessibility to the healthcare system and how healthcare providers operated during the COVID-19 pandemic may have had unintended consequences on use and safety of opioids, due to the shift in focus to preventing COVID-19 from overwhelming the healthcare system. The findings from this review support the need to continue surveillance in the United Kingdom, including the impact of the COVID-19 pandemic on opioid utilization and safety.


Assuntos
Analgésicos Opioides/administração & dosagem , COVID-19/prevenção & controle , Uso Indevido de Medicamentos/prevenção & controle , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Analgésicos Opioides/efeitos adversos , Acesso aos Serviços de Saúde , Humanos , Transtornos Relacionados ao Uso de Opioides/terapia , Cuidados Paliativos/métodos , Pandemias , SARS-CoV-2 , Assistência Terminal/métodos , Reino Unido/epidemiologia
6.
Surg Clin North Am ; 101(3): 489-497, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34048768

RESUMO

Esophageal cancer commonly presents in advanced stage, and many patients will require palliative intervention. Endoscopic stenting remains an excellent first-line therapy; however, this should be discussed in a multidisciplinary setting, considering expectations for long-term survival.


Assuntos
Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/terapia , Cuidados Paliativos/métodos , Equipe de Assistência ao Paciente , Papel do Médico , Cirurgiões , Humanos , Cuidados Paliativos/organização & administração
7.
Medicine (Baltimore) ; 100(21): e26192, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032780

RESUMO

ABSTRACT: To assess effectiveness and safety associated with radioactive stenting for hilar cholangiocarcinoma (HCCA) patients.This single-center retrospective study compared baseline and treatment data of recruited consecutive patients with HCCA underwent either normal or radioactive stenting between January 2016 and December 2019. Clinical success was defined by total bilirubin (TBIL) levels falling below 70% of the preoperative baseline within 2 weeks post stent insertion.Sixty-five patients with inoperable HCCA underwent normal (n = 35) or radioactive (n = 30) stenting at our center. Technical success of both types of the normal and radioactive stent insertion was 100%. Each patient received 1 stent. In the radioactive stent group, each patient received 1 radioactive seed strand (RSS), containing 10 to 12 radioactive seeds. Clinical success rates were 86.8% and 100% in normal and radioactive groups, respectively (P = .495). We observed stent dysfunction in 9 patients (normal group) and 7 patients (radioactive group) (P = .824). Median duration of stent patency was 165 days (normal group) and 226 days (radioactive group) (P < .001). During follow-up, all patients died from tumor progression, with respective median survival of 198 days (normal group) and 256 days (radioactive group) (P < .001). Seven and 5 patients in the normal and radioactive groups suffered from stent-related complications (P = .730).Radioactive stenting is effective and safe for inoperable HCCA patient and may prolong stent patency and survival.


Assuntos
Neoplasias dos Ductos Biliares/complicações , Colangiocarcinoma/complicações , Colestase/prevenção & controle , Radioisótopos do Iodo/administração & dosagem , Cuidados Paliativos/métodos , Stents , Idoso , Neoplasias dos Ductos Biliares/radioterapia , Colangiocarcinoma/radioterapia , Desenho de Equipamento , Feminino , Humanos , Radioisótopos do Iodo/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents/efeitos adversos , Análise de Sobrevida
8.
Curr Opin Psychiatry ; 34(4): 357-362, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33993168

RESUMO

PURPOSE OF REVIEW: Opioid use is prevalent in the United Kingdom and prior to the COVID-19 pandemic it had been recognized that the safety of opioids was an important issue to be monitored by the UK medicines regulatory agency. With the emergence of COVID-19, this requirement has been even greater. This review was undertaken to determine the impact of the pandemic on safety and surveillance of opioids in the United Kingdom. RECENT FINDINGS: During the COVID-19 pandemic, the surveillance of opioids in the United Kingdom continued, although primary research was often conducted with data prior to the pandemic. Of those studies that were conducted while the pandemic was ongoing, access to opioids (or opioid substitution therapy) and the subsequent effect on patient safety was the main theme. SUMMARY: In the United Kingdom, changes in accessibility to the healthcare system and how healthcare providers operated during the COVID-19 pandemic may have had unintended consequences on use and safety of opioids, due to the shift in focus to preventing COVID-19 from overwhelming the healthcare system. The findings from this review support the need to continue surveillance in the United Kingdom, including the impact of the COVID-19 pandemic on opioid utilization and safety.


Assuntos
Analgésicos Opioides/administração & dosagem , COVID-19/prevenção & controle , Uso Indevido de Medicamentos/prevenção & controle , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Analgésicos Opioides/efeitos adversos , Acesso aos Serviços de Saúde , Humanos , Transtornos Relacionados ao Uso de Opioides/terapia , Cuidados Paliativos/métodos , Pandemias , SARS-CoV-2 , Assistência Terminal/métodos , Reino Unido/epidemiologia
9.
Medicine (Baltimore) ; 100(20): e25785, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011038

RESUMO

RATIONALE: Esophageal carcinoma is an aggressive cancer with extremely poor therapeutic outcomes due to its high metastatic potential and a significant risk of recurrence after radical resection. Liver is the most common metastatic target organ of esophageal carcinoma, followed by the lungs, bones, and brain. Few cases of solitary pancreatic and hepatic metastases of esophageal carcinoma have been reported. PATIENT CONCERNS: We report the case of a 67-year-old male presenting with pancreatic and hepatic lesions. In addition, a friable lesion with an irregular nodular surface in the distal esophagus was detected by esophagogastroduodenoscopy. DIAGNOSIS: Pathohistological examination confirmed esophageal squamous cell carcinoma. The pancreatic lesion was also biopsied via ultrasound-guided fine needle aspiration, which also revealed squamous cell carcinoma. The hepatic lesion was also identified as metastatic carcinoma by magnetic resonance imaging, most likely of the same origin. INTERVENTIONS: Due to comorbidities that precluded surgery, the patient was administered adjuvant therapy and a multidisciplinary decision was made for palliative care. OUTCOMES: The patient died 1 month later due to multiorgan failure caused by hemorrhage from a peptic ulcer. CONCLUSION: To our knowledge, this is only the sixth case of pancreatic metastasis of esophageal squamous cell carcinoma. This case report suggests to clinicians the importance of considering potential comorbidities in every patient with advanced cancer, such as gastric ulcer and cachexia.


Assuntos
Neoplasias Esofágicas/diagnóstico , Carcinoma de Células Escamosas do Esôfago/diagnóstico , Neoplasias Hepáticas/diagnóstico , Cuidados Paliativos/métodos , Neoplasias Pancreáticas/diagnóstico , Idoso , Quimioterapia Adjuvante , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Endoscopia do Sistema Digestório , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas do Esôfago/secundário , Carcinoma de Células Escamosas do Esôfago/terapia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Evolução Fatal , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Imageamento por Ressonância Magnética , Masculino , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Neoplasias Pancreáticas/secundário , Neoplasias Pancreáticas/terapia
10.
Ann Hematol ; 100(6): 1377-1389, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33954817

RESUMO

Patients undergoing allogeneic stem cell transplantation (allo-SCT) are given a real chance of cure, but at the same time are confronted with a considerable risk of mortality and of severe long-term impediments. This narrative, non-systematic literature review aims to describe the supportive and palliative care needs of allo-SCT recipients, including long-term survivors or those relapsing or dying after transplantation. It also evaluates the feasibility and effectivity of integrating palliative care early in transplant procedures. In this appraisal of available literature, the main findings relate to symptoms like fatigue and psychological distress, which appear to be very common in the whole allo-SCT trajectory and might even persist many years post-transplantation. Chronic GvHD has a major negative impact on quality of life. Overall, there is a paucity of research on further issues in the context of allo-SCT, like the distress related to the frequently unpredictable post-transplant trajectory and prognosis, as well as the end-of-life phase. First randomized controlled results support the effectiveness of early integration of specialized palliative care expertise into transplant algorithms. Barriers to this implementation are discussed.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Cuidados Paliativos , Transplante Homólogo , Doença Crônica , Fadiga/epidemiologia , Doença Enxerto-Hospedeiro/epidemiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Cuidados Paliativos/métodos , Angústia Psicológica , Qualidade de Vida , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodos
11.
Anticancer Res ; 41(5): 2495-2499, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952477

RESUMO

BACKGROUND/AIM: Sino-nasal cancer is rare and often diagnosed at advanced stages. Some patients cannot receive curative treatment and are treated with palliative irradiation. We aimed to identify prognostic factors for survival to facilitate treatment personalization for this group. PATIENTS AND METHODS: Twelve patients treated with palliative radiotherapy for locally advanced sino-nasal cancer were retrospectively analyzed for survival. Ten characteristics were evaluated including age, gender, Karnofsky performance score (KPS), pre-radiotherapy hemoglobin, tumor site, lymph node involvement, histology, equivalent dose in 2 Gy-fractions, completion of radiotherapy and concurrent chemotherapy. RESULTS: On univariate analysis, KPS ≥70 (p<0.001) and completion of radiotherapy (p<0.001) were significantly associated with better survival. Chemotherapy showed a trend (p=0.097). In the multivariate analysis, KPS ≥70 was significant (p=0.025), and completion of radiotherapy showed a trend (p=0.080). CONCLUSION: KPS is an independent predictor of survival for palliative irradiation of sino-nasal cancer. Patients require close monitoring and care for side effects, since completion of radiotherapy is important for survival.


Assuntos
Neoplasias Nasais/radioterapia , Cuidados Paliativos/métodos , Radioterapia/métodos , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Neoplasias Nasais/patologia , Teste de Desfecho Sinonasal
12.
Pediatr Cardiol ; 42(5): 1224-1232, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33977322

RESUMO

BACKGROUND: The impact of published evidence on clinical practice has been understudied in pediatric cardiology. OBJECTIVE: We sought to assess changes in prescribing behavior for angiotensin-converting enzyme inhibitor (ACEI) and digoxin at discharge after initial palliation of infants with single ventricle (SV) physiology following the publication of two large studies: The Pediatric Heart Network Infant Single Ventricle (PHN-ISV) trial showing no benefit with routine ACEI use and the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) analysis showing an association between digoxin and survival. METHODS: ICD-9-10 codes identified SV infants from the Pediatric Health Information System (1/2004 to 1/2018) and charge codes identified medications at discharge. Generalized estimating equations implementing segmented logistic regressions modeled medication use, before and after (with a 3-month washout period) the relevant publication (ACEI 7/1/2010; digoxin 4/1/2016). A subgroup analysis was performed for hypoplastic left heart syndrome (HLHS). RESULTS: ACEI use (37 centers, n = 4700) at discharge did not change over time during the pre-publication period. After publication of the PHN-ISV trial, ACEI use decreased (OR: 0.61, CI 0.44-0.84, p = 0.003). Digoxin use (43 centers, n = 4778) decreased by 1% monthly before publication. After the NPC-QIC publication, digoxin use increased (OR: 2.07, CI 1.05-4.08, p = 0.04) with an ongoing increase of 9% per month. Results were similar for the HLHS subgroup. CONCLUSIONS: Prescribing behavior changed congruently after the publication of evidence-based studies, with decreased ACEI use and increased digoxin use at discharge following initial palliation of SV infants. Our findings suggest scientific findings were rapidly implemented into clinical practice.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Digoxina/uso terapêutico , Padrões de Prática Médica , Coração Univentricular/tratamento farmacológico , Feminino , Humanos , Síndrome do Coração Esquerdo Hipoplásico/mortalidade , Lactente , Masculino , Procedimentos de Norwood/normas , Cuidados Paliativos/métodos , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos
13.
Mayo Clin Proc ; 96(5): 1276-1287, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33958058

RESUMO

Over the past 40 years, the medical and surgical management of congenital heart disease has advanced considerably. However, substantial room for improvement remains for certain lesions that have high rates of morbidity and mortality. Although most congenital cardiac conditions are well tolerated during fetal development, certain abnormalities progress in severity over the course of gestation and impair the development of other organs, such as the lungs or airways. It follows that intervention during gestation could potentially slow or reverse elements of disease progression and improve prognosis for certain congenital heart defects. In this review, we detail specific congenital cardiac lesions that may benefit from fetal intervention, some of which already have documented improved outcomes with fetal interventions, and the state-of-the-science in each of these areas. This review includes the most relevant studies from a PubMed database search from 1970 to the present using key words such as fetal cardiac, fetal intervention, fetal surgery, and EXIT procedure. Fetal intervention in congenital cardiac surgery is an exciting frontier that promises further improvement in congenital heart disease outcomes. When fetuses who can benefit from fetal intervention are identified and appropriately referred to centers of excellence in this area, patient care will improve.


Assuntos
Terapias Fetais/métodos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/terapia , Conforto do Paciente , Assistência Perinatal/métodos , Diagnóstico Pré-Natal , Feminino , Humanos , Recém-Nascido , Cuidados Paliativos/métodos , Gravidez , Prognóstico
14.
BMC Cancer ; 21(1): 413, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858353

RESUMO

BACKGROUND: This study analyzed the clinical results of palliative radiotherapy for bleeding control in patients with unresectable advanced gastric cancer. METHODS: We retrospectively reviewed the medical records of patients who met the following inclusion criteria between January 2002 and June 2018: histologically proven gastric cancer, gastric tumor bleeding confirmed by upper gastrointestinal endoscopy, and palliative radiotherapy performed for hemostasis. The median radiotherapy dose was 30 Gy, with a daily dose ranging from 1.8 to 3 Gy. RESULTS: Sixty-one patients were included in this analysis. The study population was predominantly male (72.1%), with a median age of 62 years (range: 32-92). The median baseline hemoglobin level was 7.1 g/dL, and the most common presenting symptom of gastric tumor bleeding was melena (85.2%). Bleeding control was achieved in 54 (88.5%) patients. The median levels of hemoglobin at 1, 2, and 3 months after completion of radiotherapy were 10.1 g/dL, 10.2 g/dL, and 10.4 g/dL, respectively; these values were significantly different from that before radiotherapy (7.1 g/dL; p < 0.001). The median overall survival was 4.8 months. Among the 54 patients who achieved bleeding control after radiotherapy, 19 (35.2%) experienced re-bleeding during the follow-up period. The median time to re-bleeding was 6.0 months. Multivariate analysis demonstrated that a higher radiation dose (p = 0.007) and additional chemotherapy after radiotherapy (p = 0.004) were significant factors for prolonging the time to re-bleeding. CONCLUSIONS: Tumor bleeding was adequately controlled by radiotherapy in patients with unresectable advanced gastric cancer.


Assuntos
Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/prevenção & controle , Cuidados Paliativos , Radioterapia Adjuvante , Neoplasias Gástricas/complicações , Neoplasias Gástricas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemostasia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Paliativos/métodos , Prognóstico , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Estudos Retrospectivos , Neoplasias Gástricas/sangue , Neoplasias Gástricas/patologia
15.
Sci Prog ; 104(2): 368504211010626, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1195899

RESUMO

The Coronavirus (COVID-19) pandemic had a huge impact on all sectors around the world. In particular, the healthcare system has been subject to an enormous pressure that has surpassed its ability in many instances. Additionally, the pandemic has called for a review of our daily medical practices, including our approach to colorectal cancer management where treatment puts patients at high risk of virus exposure. Given their higher median age, patients are at an increased risk for severe symptoms and complications in cases of infection, especially in the setting of immunosuppression. Therefore, a review of the routine colorectal cancer practices is needed to minimize risk of exposure. Oncologists should weigh risk of exposure versus the patient's oncologic benefits when approaching management. In addition, treatment protocols should be modified to minimize hospital visits and admissions while maintaining the same treatment efficacy. In this review, we will focus on challenges that colorectal cancer patients face during the pandemic, while highlighting the priority in each case. We will also discuss the evidence for potential modifications to existing treatment plans that could reduce infectious exposure without compromising care. Finally, we will discuss the impact of the socio-economic difficulties faced by Lebanese patients due to a poor economy toppled by an unexpected pandemic.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , COVID-19/prevenção & controle , Infecção Hospitalar/prevenção & controle , Neoplasias/tratamento farmacológico , Pandemias , SARS-CoV-2/patogenicidade , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/transmissão , Gerenciamento Clínico , Fluoruracila/uso terapêutico , Humanos , Controle de Infecções/organização & administração , Líbano/epidemiologia , Monitorização Fisiológica/métodos , Estadiamento de Neoplasias , Neoplasias/patologia , Compostos Organoplatínicos/uso terapêutico , Cuidados Paliativos/métodos , Equipamento de Proteção Individual/provisão & distribuição , Piridinas/uso terapêutico , Telemedicina/métodos
16.
Anticancer Res ; 41(4): 1971-1974, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: covidwho-1168333

RESUMO

BACKGROUND/AIM: Oncological care has faced several challenges during the COVID-19 pandemic, e.g. treatment delay and worsening symptoms. Patient-reported anxiety, depression and sleep quality might have changed due to these special circumstances. Therefore, we analyzed the symptom burden of patients treated with palliative radiotherapy at our center. PATIENTS AND METHODS: A retrospective study was performed of 50 consecutive patients and the results were compared to those obtained in a previous pre-COVID study. The Edmonton Symptom Assessment Scale was employed to assess the preradiotherapy symptoms. RESULTS: The highest mean scores were reported for pain in activity (3.2) and dry mouth (3.1). Regarding anxiety, sadness/depression and sleep, the corresponding scores were 1.5, 1.2 and 2.7, respectively. Compared to the previous study, no significant increases were found. Most items had numerically lower mean values, e.g. anxiety (1.5 vs. 2.7). Both study populations had comparable median age (70.5 vs. 70 years), gender distribution and proportion of patients with bone metastases. However, there were two significant imbalances, namely a lower proportion of patients with prostate cancer (12 vs. 30%, p=0.02) and breast cancer (0 vs. 12%, p=0.02). CONCLUSION: In patients who showed up for radiation treatment planning, the suspected increase in anxiety, sadness/depression and sleep disturbance was not demonstrable. It is not known whether or not patients with substantial worries chose to decline referral to palliative radiotherapy. Therefore, comprehensive large-scale studies of patterns of care are needed to fully understand the impact of COVID-19-related measures.


Assuntos
COVID-19/epidemiologia , Efeitos Psicossociais da Doença , Neoplasias/radioterapia , Cuidados Paliativos/métodos , Pandemias , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/etiologia , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/secundário , Dor do Câncer/diagnóstico , Dor do Câncer/epidemiologia , Dor do Câncer/etiologia , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/epidemiologia , Neoplasias/patologia , Noruega/epidemiologia , Estudos Retrospectivos , SARS-CoV-2/fisiologia , Análise de Sobrevida , Avaliação de Sintomas
17.
Nutrients ; 13(3)2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33808957

RESUMO

Cancer cachexia subsequently shifts to refractory cachexia, however, it is not easy to properly differentiate them in clinical settings. Patients considered refractory cachexia may include cachectic patients with starvation. This study aimed to identify these cachectic patients and to evaluate the effect of nutritional intervention for them. Study subjects were terminal cancer patients admitted for palliative care and were judged refractory cachexia in the last five years. We retrospectively examined to find useful indices for identifying such cachectic patients and for evaluating the effect of nutritional intervention. Out of 223 patients in refractory cachexia, 26 were diagnosed cachexia with starvation after symptom management. Comparing before and one week after this management, Palliative Performance Scale (PPS) and transthyretin significantly improved (p < 0.0001, p = 0.0002, respectively) Then, we started nutritional intervention for these cachectic patients and divided into effective group (n = 17) and non-effective group (n = 9) using the criteria for cachexia. Comparing between the two groups, PPS significantly improved2 weeks after intervention in effective group (p = 0.006). Survival time was significantly longer in effective group (p = 0.008). PPS and transthyretin were useful for differential diagnosis of cachexia and refractory cachexia. PPS was useful for evaluating nutritional intervention for cachectic patients. Appropriate nutritional intervention improved survival.


Assuntos
Caquexia/diagnóstico , Neoplasias/complicações , Apoio Nutricional/métodos , Assistência Terminal/métodos , Adulto , Caquexia/dietoterapia , Caquexia/etiologia , Caquexia/mortalidade , Diagnóstico Diferencial , Humanos , Neoplasias/dietoterapia , Neoplasias/mortalidade , Cuidados Paliativos/métodos , Nutrição Parenteral , Falha de Tratamento
18.
BMC Cancer ; 21(1): 339, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789626

RESUMO

BACKGROUND: Despite advances in treatment, multiple myeloma (MM) remains incurable and results in significant morbidity and mortality. Further research investigating where MM patients die and characterization of end-of-life hospitalizations is needed. METHODS: We utilized the National Inpatient Sample (NIS) to explore the hospitalization burden of MM patients at the end of their lives. RESULTS: The percent of patients dying in the hospital as a percent of overall MM deaths ranged from 54% in 2002 to 41.4% in 2017 (p < 0.01). Blood transfusions were received in 32.7% of these hospitalizations and infections were present in 47.8% of patients. Palliative care and/or hospice consultations ranged from 5.3% in 2002 to 31.4% in 2017 (p < 0.01). CONCLUSION: Our study demonstrates that patients with MM dying in the hospital have a significant requirement for blood transfusions and have a high infection burden. We also show that palliative care and hospice involvement at the end of life has increased over time but remains low, and that ultimately, inpatient mortality has decreased over time, but MM patients die in the hospital at a higher rate than the general population.


Assuntos
Mieloma Múltiplo/reabilitação , Cuidados Paliativos/métodos , Assistência Terminal/métodos , Idoso , Feminino , Hospitalização , Humanos , Masculino , Mieloma Múltiplo/mortalidade , Análise de Sobrevida
19.
Anticancer Res ; 41(4): 1971-1974, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813403

RESUMO

BACKGROUND/AIM: Oncological care has faced several challenges during the COVID-19 pandemic, e.g. treatment delay and worsening symptoms. Patient-reported anxiety, depression and sleep quality might have changed due to these special circumstances. Therefore, we analyzed the symptom burden of patients treated with palliative radiotherapy at our center. PATIENTS AND METHODS: A retrospective study was performed of 50 consecutive patients and the results were compared to those obtained in a previous pre-COVID study. The Edmonton Symptom Assessment Scale was employed to assess the preradiotherapy symptoms. RESULTS: The highest mean scores were reported for pain in activity (3.2) and dry mouth (3.1). Regarding anxiety, sadness/depression and sleep, the corresponding scores were 1.5, 1.2 and 2.7, respectively. Compared to the previous study, no significant increases were found. Most items had numerically lower mean values, e.g. anxiety (1.5 vs. 2.7). Both study populations had comparable median age (70.5 vs. 70 years), gender distribution and proportion of patients with bone metastases. However, there were two significant imbalances, namely a lower proportion of patients with prostate cancer (12 vs. 30%, p=0.02) and breast cancer (0 vs. 12%, p=0.02). CONCLUSION: In patients who showed up for radiation treatment planning, the suspected increase in anxiety, sadness/depression and sleep disturbance was not demonstrable. It is not known whether or not patients with substantial worries chose to decline referral to palliative radiotherapy. Therefore, comprehensive large-scale studies of patterns of care are needed to fully understand the impact of COVID-19-related measures.


Assuntos
COVID-19/epidemiologia , Efeitos Psicossociais da Doença , Neoplasias/radioterapia , Cuidados Paliativos/métodos , Pandemias , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/etiologia , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/secundário , Dor do Câncer/diagnóstico , Dor do Câncer/epidemiologia , Dor do Câncer/etiologia , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/epidemiologia , Neoplasias/patologia , Noruega/epidemiologia , Estudos Retrospectivos , SARS-CoV-2/fisiologia , Análise de Sobrevida , Avaliação de Sintomas
20.
Emerg Med Clin North Am ; 39(2): 443-452, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33863471

RESUMO

The incorporation of palliative care to address the needs of the older adult is a vital part of emergency medicine. Recognizing the trajectory of chronic diseases in older adults and the myriad of medical diseases amenable to palliative care is paramount. Early involvement of palliative care should be considered the cornerstone to overarching management of the older adult presenting to the emergency department.


Assuntos
Serviço Hospitalar de Emergência , Cuidados Paliativos/métodos , Idoso , Medicina de Emergência , Humanos
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