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Fainsinger RL, Gramlich LM. How Often Can We Justify Parenteral Nutrition in Terminally Ill Cancer Patients? J Palliat Care 2019. [DOI: 10.1177/082585979701300109] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Leah M. Gramlich
- Nutrition Support Services, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Tsang KL, Carlson LE, Olson K. Pilot Crossover Trial of Reiki Versus Rest for Treating Cancer-Related Fatigue. Integr Cancer Ther 2016; 6:25-35. [PMID: 17351024 DOI: 10.1177/1534735406298986] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fatigue is an extremely common side effect experienced during cancer treatment and recovery. Limited research has investigated strategies stemming from complementary and alternative medicine to reduce cancer-related fatigue. This research examined the effects of Reiki, a type of energy touch therapy, on fatigue, pain, anxiety, and overall quality of life. This study was a counterbalanced crossover trial of 2 conditions: (1) in the Reiki condition, participants received Reiki for 5 consecutive daily sessions, followed by a 1-week washout monitoring period of no treatments, then 2 additional Reiki sessions, and finally 2 weeks of no treatments, and (2) in the rest condition, participants rested for approximately 1 hour each day for 5 consecutive days, followed by a 1-week washout monitoring period of no scheduled resting and an additional week of no treatments. In both conditions, participants completed questionnaires investigating cancer-related fatigue (Functional Assessment of Cancer Therapy Fatigue subscale [FACT-F]) and overall quality of life (Functional Assessment of Cancer Therapy, General Version [FACT-G]) before and after all Reiki or resting sessions. They also completed a visual analog scale (Edmonton Symptom Assessment System [ESAS]) assessing daily tiredness, pain, and anxiety before and after each session of Reiki or rest. Sixteen patients (13 women) participated in the trial: 8 were randomized to each order of conditions (Reiki then rest; rest then Reiki). They were screened for fatigue on the ESAS tiredness item, and those scoring greater than 3 on the 0 to 10 scale were eligible for the study. They were diagnosed with a variety of cancers, most commonly colorectal (62.5%) cancer, and had a median age of 59 years. Fatigue on the FACT-F decreased within the Reiki condition ( P=.05) over the course of all 7 treatments. In addition, participants in the Reiki condition experienced significant improvements in quality of life (FACT-G) compared to those in the resting condition ( P <.05). On daily assessments (ESAS) in the Reiki condition, presession 1 versus postsession 5 scores indicated significant decreases in tiredness ( P <.001), pain ( P <.005), and anxiety ( P<.01), which were not seen in the resting condition. Future research should further investigate the impact of Reiki using more highly controlled designs that include a sham Reiki condition and larger sample sizes.
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Affiliation(s)
- Kathy L Tsang
- Department of Psychology, University of Calgary, Alberta, Canada
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Garcia JM, Li H, Mann D, Epner D, Hayes TG, Marcelli M, Cunningham GR. Hypogonadism in male patients with cancer. Cancer 2006; 106:2583-91. [PMID: 16688773 DOI: 10.1002/cncr.21889] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with cancer often develop anorexia, fatigue, and decreased muscle mass. These signs and symptoms are nonspecific, and they frequently occur in other conditions, including hypogonadism. METHODS The objectives of this study were 1) to measure testosterone levels in patients with cancer and 2) to examine the correlations between testosterone, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), insulin-like growth factor-1 (IGF-1), ghrelin levels, and appetite in patients with cancer patients and in a noncancer control group. This was designed as a cross-sectional study in the setting of a university-affiliated Veterans Affairs Medical Center. The study population included 31 male patients with cancer and 25 gender-matched noncancer controls of similar age. The variables total testosterone (TT), calculated free testosterone (cFT), calculated bioavailable testosterone (cBT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), TNF-alpha, IL-6, IGF-1, and active ghrelin were measured in fasting morning plasma samples. Appetite was measured according to a visual analog scale. The main outcome measures were cFT and cBT. RESULTS Cancer patients had mean TT levels similar to levels in the noncancer control group but significantly lower levels of cFT, cBT, IGF-1, and appetite. SHBG, LH, TNF-alpha, IL-6, and ghrelin levels were increased in patients with cancer compared with the control group. cFT and cBT levels were correlated inversely with IL-6 and ghrelin levels and were correlated directly with IGF-1 levels and appetite. CONCLUSIONS Patients with cancer had lower levels of biologically active testosterone. TT was not adequate for the evaluation of hypogonadism, because SHBG levels were increased. A reliable measurement of FT and/or BT should be used. LH was elevated in the patients with cancer, indicating that low FT levels were caused by primary testicular dysfunction. The authors postulated that high IL-6 or ghrelin levels inhibit testosterone synthesis, although a secondary effect at the hypothalamic-pituitary levels cannot be excluded.
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Affiliation(s)
- Jose M Garcia
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas 77030, USA.
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Abstract
The majority of patients with advanced cancer experience weight loss, reduced appetite, fatigue, and weakness. Chronic nausea and early satiety may also occur. This constellation of symptoms is known as the cancer anorexia-cachexia syndrome. Together with cancer pain, cancer anorexia-cachexia syndrome has been identified as 1 of the 2 most frequent and devastating problems affecting individuals with advanced malignancies. Research examining the issue of cancer anorexia-cachexia syndrome has been conducted; however, such work is largely biomedical in orientation. In contrast, the psychologic dimensions of the cancer anorexia-cachexia syndrome experience from the perspective of terminally ill patients and their family members is less well explored or described. The ability to provide psychosocial support to patients and families requires that caregivers appreciate the psychologic effect of cancer anorexia and cachexia on these individuals. This article examines that effect in light of existing knowledge and discusses the clinical implications arising from this work.
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Affiliation(s)
- Susan McClement
- Faculty of Nursing, University of Manitoba, Research Associate, Winnipeg, Manitoba, Canada.
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Morrow GR, Shelke AR, Roscoe JA, Hickok JT, Mustian K. Management of cancer-related fatigue. Cancer Invest 2005; 23:229-39. [PMID: 15945509 DOI: 10.1081/cnv-200055960] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Fatigue is among the most commonly reported symptoms of patients with cancer, with prevalence exceeding 60% in many studies. It is among the most distressing symptoms associated with cancer and cancer treatments because it substantially disturbs patients' quality of life and ability to function optimally on a daily basis. Although the development of this condition has been associated with a number of factors, its etiology remains poorly understood. Important elements to include in any definition of cancer-related fatigue include its pervasiveness, persistence, detrimental effect on quality of life, and its inability to be relieved by rest or sleep. Several validated questionnaires can be used to measure fatigue in patients with cancer, and research efforts are currently focused on ways to distinguish it from depression with which it shares many symptoms. All patients with cancer should be evaluated for fatigue, and treatment options should be considered for those who are experiencing excessive levels of fatigue. Treatment should be individualized according to the underlying pathology when a specific cause has been identified (e.g., anemia, sleep disorder, depression, or metabolic disorder). Nonspecific therapies may be useful in short- and long-term cancer-related fatigue management in many patients. In addition to older therapies, such as hematopoietics, antidepressants, corticosteroids, and psychostimulants, the effectiveness of the new wake-promoting agent modafinil is currently being studied. A more thorough evaluation of the various therapeutic options is required to better define their efficacy and safety profiles in this patient population.
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Affiliation(s)
- Gary R Morrow
- URCC CCOP Research Base, University of Rochester Cancer Center, Rochester, New York 14642, USA.
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Hernández JL, Riancho JA, Matorras P, González-Macías J. Clinical evaluation for cancer in patients with involuntary weight loss without specific symptoms. Am J Med 2003; 114:631-7. [PMID: 12798450 DOI: 10.1016/s0002-9343(03)00115-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE There is no established diagnostic approach to rule out cancer in patients who present with involuntary weight loss in the absence of other symptoms (isolated involuntary weight loss). We sought to evaluate the efficiency of various diagnostic studies used in these patients. METHODS We studied 306 patients referred to an urban tertiary care teaching hospital for isolated involuntary weight loss, 276 of whom were followed for at least 1 year or until a final diagnosis was reached. We collected data about the diagnostic approach, the causes of unintentional weight loss, and survival. RESULTS Of the 276 patients, 104 (38%) had cancer, mainly of the digestive system (54%, n = 56). The first diagnostic clue usually came from routine blood tests (complete blood count, erythrocyte sedimentation rate, and a biochemical profile), which led to a more targeted diagnostic procedure, such as abdominal ultrasonography, computed tomography, and gastrointestinal endoscopy. Only 2 patients with cancer had normal results in all of these tests. Nine of the patients with cancer were not detected during the initial evaluation. Median survival was 2 months among patients with cancer, and only 9 survived longer than 1 year. CONCLUSION These results suggest that a clinical approach, including routine laboratory tests (complete blood count, erythrocyte sedimentation rate, and serum albumin, aminotransferases, gamma-glutamyl transpeptidase, alkaline phosphatase, and lactate dehydrogenase levels) and abdominal ultrasonography, seems to be appropriate for detecting the majority of cases of cancer among patients with isolated involuntary weight loss.
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Affiliation(s)
- José L Hernández
- Department of Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, 39008 Santander, Spain.
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Abstract
The care of children at the end of life is gradually improving. Nevertheless, more than half suffer from intractable symptoms before dying. Although pain has been the subject of clinical research, evidence-based data are almost completely lacking for other symptoms, highlighting the need for clinical research in palliative care. We review the available evidence on fatigue, anorexia, dyspnea, respiratory secretions, cough, constipation, mouth dryness, urinary obstruction, terminal convulsions and gasping. When evidence is lacking, we offer our empiric approach. Short duration benzodiazepines have become an important component of treatment that should remain simple, while providing the dying child the comfort needed to experience the highest quality relationships with those around him.
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Affiliation(s)
- M Duval
- Service d'hémato-oncologie pédiatrique, hôpital Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, Montréal, QC, Canada, H3T 1C5.
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Hernández Hernández JL, Matorras Galán P, Riancho Moral JA, González-Macías J. [Etiologic spectrum of solitary constitutional syndrome]. Rev Clin Esp 2002; 202:367-74. [PMID: 12139819 DOI: 10.1016/s0014-2565(02)71083-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To know the spectrum of diseases responsible for the solitary constitutional syndrome in our setting. This syndrome was defined as a clinical picture characterized by the presence of asthenia, anorexia, and weight loss of at least 5% of body weight in the last six months, not associated with any other symptom or sign suggesting the diagnosis of an organ or system disease. PATIENTS AND METHODS All patients diagnosed of the solitary constitutional syndrome (328) in a tertiary-care level teaching hospital between January 1991 and December 1996. RESULTS Fifty-two (170) percent of patients with solitary constitutional syndrome were males and 48% (158) females. The mean age was 65.4%, ranging from 15 to 97 years. The average of the monthly estimated weight loss was 3 to 4 kilograms. A total of 115 (35%) malignant neoplasms and 5 (1.5%) benign tumors were diagnosed. The most common malignant tumors corresponded to the digestive tract (51.3% of the total malignant tumors). The second cause in frequency of the solitary constitutional syndrome corresponded to psychiatric diseases, with a total of 80 patients (24.3%). A total of 116 non-neoplastic organic diseases were detected, with digestive tract diseases --mainly peptic disease-- being the most common cause in this group. After follow-up, only in twenty cases were we unable to detect the underlying disease responsible for the syndrome. In nine of these, the solitary constitutional syndrome was self-limited. Forty-four percent of patients had at least another concomitant disease and in 24% of patients more than one associated condition was found. CONCLUSION The most common diseases responsible for the solitary constitutional syndrome were, by decreasing frequency, malignant tumors, psychiatric disorders, and non-malignant organic diseases located in the digestive tract. A better knowledge of the etiological spectrum of this syndrome might be useful for a more efficient management of these patients.
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Affiliation(s)
- J L Hernández Hernández
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
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Abstract
Declining physical, emotional, and social function as a result of anorexia and cachexia are considerable contributors to discomfort for cancer patients and their families, and they impair the patient's ability to express optimal physical and psychosocial potential as long as possible. This decline no longer has to be accepted as an indispensable sequel to advanced cancer, just as pain is no longer considered to be unavoidable. A routine screening for anorexia and cachexia and associated symptoms is necessary, as is a careful, comprehensive assessment, because the condition is not always obvious. Decisions about anorexia and cachexia treatment are guided by prioritizing the different, concurrent physical, psychosocial, and existential problems and by considering the natural course of the cancer and the effects of antineoplastic therapies. Reversible causes for anorexia and cachexia need to be identified and treated, if appropriate. Nutritional interventions are often indicated; patients with a predominant starvation component and without inflammation may profit the most. New pharmacologic therapies for primary anorexia and cachexia syndrome are expected to enter clinical practice soon; however, until then, treatment with corticosteroids, progestins, or prokinetics may be indicated for some patients. To understand a multicausal syndrome, multimodal and interdisciplinary therapy is required. Specialist palliative care services can be helpful to provide, hand-in-hand with the disease specialists [172], assessment and management of psychophysical symptoms and sociospiritual needs of patients during the course of the illness and at the end of life [173]. Research efforts aim to better characterize subgroups of patients suffering from secondary causes of anorexia and cachexia and to elucidate the mechanisms involved in the primary anorexia and cachexia syndrome. Increasingly individualized treatments are expected with combination treatments that involve different mechanisms including nutrition.
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Affiliation(s)
- Florian Strasser
- Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 0008, Houston, TX 77030, USA
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POROCK D. Factors influencing the severity of radiation skin and oral mucosal reactions: development of a conceptual framework. Eur J Cancer Care (Engl) 2002. [DOI: 10.1046/j.1365-2354.2002.00287.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gwilliam B, Bailey C. The nature of terminal malignant bowel obstruction and its impact on patients with advanced cancer. Int J Palliat Nurs 2001; 7:474-81. [PMID: 11923747 DOI: 10.12968/ijpn.2001.7.10.9904] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with bowel obstruction due to advanced cancer often have a poor prognosis and suffer distressing symptoms that can be difficult to manage. Research to date has focused on medical interventions and the measurement and control of symptoms. Little attention has been given to patients' perceptions of their quality of life or the impact of their illness. This study aimed to explore patients' lived experience of bowel obstruction. Semi-structured interviews were conducted with ten patients with bowel obstruction due to gynaecological or gastric cancer. Data analysis was based on an adaptation of Giorgi (1975) and Parse et al's (1985a,b) phenomenological method. Findings suggest that the 'meaning' of being unable to eat is more significant for patients than the nutritional or biological loss of food. For some patients, bowel obstruction marks a process of transition from life to death which is characterized by a sense of social disengagement and disrupted identity. Interviews highlighted aspects of the nurse-patient relationship that were therapeutic in their own right.
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Affiliation(s)
- B Gwilliam
- Department of Palliative Medicine, The Royal Marsden Hospital NHS Trust, London, UK
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Akechi T, Kugaya A, Okamura H, Yamawaki S, Uchitomi Y. Fatigue and its associated factors in ambulatory cancer patients: a preliminary study. J Pain Symptom Manage 1999; 17:42-8. [PMID: 9919864 DOI: 10.1016/s0885-3924(98)00105-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although fatigue is considered to be one of the major causes of distress among cancer patients, little is known about its association with other factors, such as demographic, medical, and psychosocial factors. A total of 455 ambulatory cancer patients completed the Profile of Mood States (POMS) scale, which includes a fatigue subscale. Other information was obtained in an interview. The results of a multiple regression analysis suggested that sex, education, employment status, the size of the household, the performance status, and depressive mood were associated with fatigue. Our findings reveal that the fatigue experienced by cancer patients may be determined by multiple factors, including demographic, physical, and psychological factors.
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Affiliation(s)
- T Akechi
- Psycho-Oncology Division, National Cancer Center Research Institute East, Chiba, Japan
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