Palliative Care for the Cancer Patient
Palliative Care Service, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.Primary care (Impact Factor: 0.74). 12/2009; 36(4):781-810. DOI: 10.1016/j.pop.2009.07.010
Palliation of symptoms to optimize QOL is the foundation of cancer care regardless of stage of disease or level of anticancer treatment. Patients commonly experience pain, constipation, nausea, vomiting, dyspnea, fatigue, and delirium. Many valid clinical tools are available to the primary care clinician to screen for symptoms, assess severity, measure treatment response, and elicit the patient's subjective symptom experience. Although there is limited evidence regarding the relative efficacy of symptom interventions from randomized controlled trials, clinical practice guidelines are available.
Article: Brain Metastases[Show abstract] [Hide abstract]
ABSTRACT: Approximately 10% of patients with cancer develop brain metastases. Some evidence indicates that as techniques for treating systemic tumors improve, the incidence of brain metastases, sequestered as they are behind the blood-brain barrier, is increasing. Although usually appearing late in the course of the disease, a brain metastasis may cause the initial symptoms, before the primary cancer has been identified. The diagnostic and therapeutic approach depends on the number and location of brain lesions and the stage of the cancer. Patients with brain metastases are rarely cured. However, appropriate treatment can improve both the quality and duration of the patient's life. Treatment must be directed not only at the brain metastasis (definitive care), but also at a multitude of other symptoms that plague patients with brain metastases (supportive care). Judicious selection of pharmacologic agents and nonpharmacologic techniques can effectively treat many serious symptoms in patients with brain metastases, but injudicious selection of pharmacologic agents may have side effects and make the patient's quality of life worse. The authors review some aspects of both definitive and supportive care with particular attention to the side effects of some commonly used pharmacologic agents.Seminars in Neurology 07/2010; 30(3):217-35. DOI:10.1055/s-0030-1255225 · 1.79 Impact Factor
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ABSTRACT: Opioid-induced bowel dysfunction (OBD) is characterized by a constellation of symptoms, including constipation; dry, hard stools; straining; and incomplete evacuation. The use of a prophylactic bowel regimen that includes a stimulant laxative and stool softener generally is accepted and should be initiated at the start of opioid therapy. Effective prevention and treatment of OBD reduce the risk of associated physiologic complications and can improve pain management and quality of life for patients and their families.Clinical Journal of Oncology Nursing 12/2010; 14(6):701-4. DOI:10.1188/10.CJON.701-704 · 0.91 Impact Factor
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ABSTRACT: Cisplatin (CDDP), one of the most active cytotoxic agents against cancer, has adverse side effects, such as nephrotoxicity and hepatotoxicity. The present study was designed to investigate the potential protective effect of pomegranate seed extract (PSE) against oxidative stress caused by CDDP injury of the kidneys and liver by measuring tissue biochemical and antioxidant variables and immunohistochemically testing caspase-3-positive cells. Twenty-four Sprague-Dawley rats were divided into 4 groups: control; CDDP: injected intraperitoneally with CDDP (7 mg/kg body weight, single dose); PSE: treated for 15 consecutive days by gavage with PSE (300 mg/kg per day); and PSE+CDDP: treated by gavage with PSE 15 days after a single injection of CDDP. The degree of protection against CDDP injury afforded by PSE was evaluated by determining the levels of malondialdehyde as a measure of lipid peroxidation. The levels of glutathione and activities of glutathione peroxidase, glutathione S-transferase, and superoxide dismutase were estimated from liver and kidney homogenates; the liver and kidney were also histologically examined. PSE elicited a significant protective effect toward liver and kidney by decreasing the level of lipid peroxidation; elevating the levels of glutathione S-transferase; and increasing the activities of glutathione peroxidase, glutathione S-transferase, and superoxide dismutase. These biochemical observations were supported by immunohistochemical findings and suggested that PSE significantly attenuated nephrotoxicity and hepatotoxicity by the way of its antioxidant, radical-scavenging, and antiapoptotic effects. This PSE extract could be used as a dietary supplement in patients receiving chemotherapy medications.Journal of medicinal food 05/2011; 14(10):1254-62. DOI:10.1089/jmf.2010.0286 · 1.63 Impact Factor
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