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Chou CP, Lai WA, Pan BL, Yang YH, Huang KS. Effects of Hospice Care for Terminal Head and Neck Cancer Patients: A Nationwide Population-Based Matched Cohort Study. J Palliat Med 2021; 24:1299-1306. [PMID: 33434098 DOI: 10.1089/jpm.2020.0375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Background: Head and neck cancer was the fourth-most common cause of cancer death among Taiwanese men in 2018. Hospice care has been proven to reduce the use of invasive medical interventions and expenditures in caring for cancer patients. Aim: This study examined the effects of hospice care for terminal head and neck cancer patients. Design: A matched cohort study was used to compare the use of invasive interventions and expenditures among hospice care and nonhospice care patients. Setting/Participants: The investigated patients consisted of patients who died of head and neck cancer in Taiwan from 2004 to 2013 and were included in the Registry for Catastrophic Illness Patients in Taiwan and the Taiwan National Health Research Insurance Database. Results: A total of 45,948 terminal head and neck cancer patients were identified, and 9883 patients remained in each group after matching for comorbidities. After that matching, the rates of intensive care unit admission (23.9% vs. 38.94%, p < 0.0001), endotracheal intubation (10.05% vs. 31.32%, p < 0.0001), cardiopulmonary resuscitation (2.93% vs. 20.18%, p < 0.0001), defibrillation (0.51% vs. 4.36%. p < 0.0001), ventilator use (21.92% vs. 46.47%, p < 0.0001), blood transfusion (71.25% vs. 73.45%, p = 0.006), and hemodialysis (1.06% vs. 3.26%. p < 0.0001) were significantly lower in the hospice group than the nonhospice group, although the rates of parenteral nutrition for the two groups were similar (7.74% vs. 7.97%, p = 0.5432). The mean medical expenditure per person in the six months before death was 460,531 New Taiwan Dollar (NTD) for the nonhospice group and 389,079 NTD for those provided hospice care for more than three months, which was the lowest amount among various hospice enrollment durations. Conclusions: Hospice care can effectively reduce the use of invasive medical interventions in caring for terminal head and neck cancer patients and may improve their quality of death. Moreover, hospice care enrollment for more than three months can save on unnecessary medical expenditures for terminal head and neck cancer patients.
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Affiliation(s)
- Chia-Pei Chou
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-An Lai
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Bo-Lin Pan
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kun-Siang Huang
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Abid MA, Abid MB. Commentary: Dietary methionine influences therapy in mouse cancer models and alters human metabolism. Front Oncol 2020; 10:1071. [PMID: 32733800 PMCID: PMC7357428 DOI: 10.3389/fonc.2020.01071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/28/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Muhammad Abbas Abid
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Muhammad Bilal Abid
- Divisions of Hematology/Oncology & Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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Curtin M, Piggott RP, Murphy EP, Munigangaiah S, Baker JF, McCabe JP, Devitt A. Spinal Metastatic Disease: A Review of the Role of the Multidisciplinary Team. Orthop Surg 2017; 9:145-151. [PMID: 28544780 DOI: 10.1111/os.12334] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/02/2017] [Indexed: 12/16/2022] Open
Abstract
Historically, a simple approach centered on palliation was applicable to the majority of patients with metastatic spinal disease. With advances in diagnosis and treatment, a more complicated algorithm has devolved requiring a multidisciplinary approach with institutional commitment and support. We performed a database review including pertinent articles exploring the multidisciplinary management of spinal metastatic disease. The wide variation in clinical presentation and tumor response to treatment necessitates a multidisciplinary approach that integrates the diagnosis and treatment of the cancer, symptom management, and rehabilitation for optimal care of patients with spinal metastases. Advances in the field of radiology have led to earlier and more focused diagnosis of spinal metastasis and acts to guide therapy. Advances in surgical techniques, neurophysiologic monitoring, and anesthetic expertise have allowed surgeons to perform more extensive procedures leading to improved outcomes and reduced morbidity. Radiation oncology input that is essential as external beam radiation therapy can provide significant pain relief. Non-operative measures may include bisphosphonate infusions, management of complications (e.g. hypercalcemia of malignancy), monoclonal antibody infusions, and chemotherapy if indicated in the treatment of the primary malignancy. Input from psychology services is necessary to address the biopsychosocial ramifications of spinal metastasis. Allied health professionals in the form of physiotherapists, social workers, and dieticians also contribute in maximizing patients' quality of life and well-being.
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Affiliation(s)
- Mark Curtin
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Robert P Piggott
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Evelyn P Murphy
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Sudarshan Munigangaiah
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Joseph F Baker
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - John P McCabe
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Aiden Devitt
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
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Huang KS, Wang SH, Chuah SK, Rau KM, Lin YH, Hsieh MC, Shih LH, Chen YH. The effects of hospice-shared care for gastric cancer patients. PLoS One 2017; 12:e0171365. [PMID: 28158232 PMCID: PMC5291360 DOI: 10.1371/journal.pone.0171365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 01/19/2017] [Indexed: 02/05/2023] Open
Abstract
Background Hospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients. Methods A total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93) and a control group (n = 81). Results Among the 174 patients, 84% had advanced stage (stage III or stage IV) cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001) and those cared by other physicians (63% vs 41%, p = 0.004). Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, p<0.001), intubation (1% vs 27%, p<0.001), cardiopulmonary-cerebral resuscitation (0% vs 11%, p = 0.001), ventilator use (1% vs 27%, p<0.001), inotropic agent use (8% vs 46%, p<0.001), total or partial parenteral nutrition use (38% vs. 58%, p = 0.029), and blood transfusion (45% vs 74%, p<0.001). Besides, the hospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR) orders (95% vs 37%, p<0.001), receiving home hospice care (16% vs 1%, p<0.001), and indicating home as the realistically preferred place of death (41% vs 19%, p = 0.001). The hospice ward admission rate in the hospice-shared care group increased from 30% to 53% from 2012 to 2014. Conclusion The use of hospice-shared care for gastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life.
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Affiliation(s)
- Kun-Siang Huang
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Ho Wang
- Division of General surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kun-Ming Rau
- Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Hung Lin
- Division of General surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Meng-Che Hsieh
- Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Li-Hsueh Shih
- Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yen-Hao Chen
- Gastric cancer team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Hospice care team in Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- * E-mail:
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Fan BG. Parenteral Nutrition Prolongs the Survival of Patients Associated With Malignant Gastrointestinal Obstruction. JPEN J Parenter Enteral Nutr 2017; 31:508-10. [DOI: 10.1177/0148607107031006508] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bo-Guang Fan
- From the Department of Surgery, Wenzhou Medical College, Taizhou
Hospital, Zhejiang, China
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Dy SM. Enteral and Parenteral Nutrition in Terminally Ill Cancer Patients: A Review of the Literature. Am J Hosp Palliat Care 2016; 23:369-77. [PMID: 17060304 DOI: 10.1177/1049909106292167] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Many terminally ill patients who are able to eat appear to be eating less than they should, losing weight, and becoming malnourished, and many others develop difficulties with eating. These symptoms and signs are usually a marker of advanced cancer, rather than the cause of decreasing functional status, and providing supplemental nutrition rarely changes the course of the disease. This article reviews evidence on issues relevant to enteral and parenteral nutrition in patients with advanced cancer, including benefits, risks, and discomforts; how these types of nutrition are used and perceived, and how decisions are made; and how decision-making might be improved.
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Affiliation(s)
- Sydney Morss Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, USA.
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Madhok BM, Yeluri S, Haigh K, Burton A, Broadhead T, Jayne DG. Parenteral nutrition for patients with advanced ovarian malignancy. J Hum Nutr Diet 2010; 24:187-91. [DOI: 10.1111/j.1365-277x.2010.01127.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mirhosseini M, Fainsinger R. Parenteral Nutrition in Patients with Advanced Cancer #190. J Palliat Med 2009; 12:260-1. [DOI: 10.1089/jpm.2009.9660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Soo I, Gramlich L. Use of parenteral nutrition in patients with advanced cancer. Appl Physiol Nutr Metab 2008; 33:102-6. [DOI: 10.1139/h07-152] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study is to describe patient-related variables in a cohort of advanced cancer patients (ACPs) enrolled in a home parenteral nutrition (HPN) program. This study reviewed the cohort of ACPs enrolled in the Northern Alberta Home Total Parenteral Nutrition Program (NAHTPNP). Thirty-eight ACPs received HPN during the study period, 24% of all patients admitted for PN. Of these, 27 (71%) were female. Mean age was 48.76 y (SD 13.8 y). Bowel obstruction was the most common indication for initiating HPN (84%, 32) and ovarian cancer was the most common malignancy (34%, 13). Patients who began HPN with a Karnofsky performance status (KPS) of greater than 50 (median of 70) were found to have a longer duration of life (median: 6 months) compared with patients who began HPN with a KPS of 50 or below (median = 50; median 3 months; p = 0.01; two-tailed). There was no difference in survival between malignancy type (p = NS). Advanced cancer is the fastest growing indication for enrollment in the HPN program. ACP demonstrated a 3% average annual increase proportionate to all indications for HPN starts, accounting for 7%–48% of HPN starts from 1999–2006. HPN is an increasingly used therapy for patients with advanced cancer, most commonly for intestinal failure in the setting of bowel obstruction. Initiation of HPN at a higher KPS was associated with a longer duration of life. Further studies are needed to validate the use of TPN in end-stage cancer patients.
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Affiliation(s)
- Isaac Soo
- Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2E1
- Division of Gastroenterology, Faculty of Medicine, University of Alberta, 323 CSC Royal Alexandra Hospital, Edmonton, AB T5H 3V9
| | - Leah Gramlich
- Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2E1
- Division of Gastroenterology, Faculty of Medicine, University of Alberta, 323 CSC Royal Alexandra Hospital, Edmonton, AB T5H 3V9
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Oz V, Theilla M, Singer P. Eating habits and quality of life of patients receiving home parenteral nutrition in Israel. Clin Nutr 2008; 27:95-9. [DOI: 10.1016/j.clnu.2007.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 04/15/2007] [Accepted: 06/19/2007] [Indexed: 10/22/2022]
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Brard L, Weitzen S, Strubel-Lagan SL, Swamy N, Gordinier ME, Moore RG, Granai CO. The effect of total parenteral nutrition on the survival of terminally ill ovarian cancer patients. Gynecol Oncol 2006; 103:176-80. [PMID: 16564074 DOI: 10.1016/j.ygyno.2006.02.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 02/04/2006] [Accepted: 02/08/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Total parenteral nutrition (TPN) for terminal ovarian cancer patients remains controversial. In this study, we compared survival from time of terminal intestinal obstruction (TIO) diagnosis in patients who received TPN versus those who did not. METHODS A historical cohort of 55 patients with stage IIIC/IV epithelial ovarian cancer hospitalized for TIO between 1994 and 2002 was studied. All patients were previously treated with paclitaxel/platinum following cytoreductive surgery. Exposure was administration of TPN after TIO. The primary outcome was survival from TIO diagnosis to death. Number of chemotherapy cycles completed after TIO diagnosis, major complications of TPN, and demographics were measured. Survival analysis was performed using Kaplan-Meier methods. RESULTS The median survival from time of TIO diagnosis was 72 days (range 16-485) for patients receiving TPN and 41.0 days (range 4-133) for those not receiving TPN (P = 0.05), but no difference in survival was observed when adjusting for chemotherapy. Overall survival [median 23 (range 6-67) vs. 35 months (range 8-67), P = 0.03] was shorter for the TPN group. Demographic data were similar in both groups. Patients receiving TPN after obstruction were more likely to undergo concurrent chemotherapy (64 vs. 26%, P = 0.004). One major TPN-related complication was found. CONCLUSIONS Ovarian cancer patients with TIO receiving TPN had a median survival benefit of 4 weeks. This benefit decreased when patients were treated with concurrent chemotherapy. Issues of cost, quality of life, and human values need to be investigated to assess the full impact of TPN in this patient population.
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Affiliation(s)
- Laurent Brard
- Department of Obstetrics and Gynecology, Women and Infants' Hospital, Brown University, 101 Dudley Street, Providence, RI 02905, USA.
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Santarpia L, Alfonsi L, Pasanisi F, De Caprio C, Scalfi L, Contaldo F. Predictive factors of survival in patients with peritoneal carcinomatosis on home parenteral nutrition. Nutrition 2006; 22:355-60. [PMID: 16413750 DOI: 10.1016/j.nut.2005.06.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 06/03/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We worked to identify predictors of survival in patients with carcinomatosis on home parenteral nutrition (HPN). METHODS Survival rate was evaluated in 152 terminal patients (45 men and 107 women) with peritoneal carcinosis on HPN. Selected anthropometric measurements (weight and body mass index), laboratory tests (serum albumin, cholesterol, cholinesterase [CHE], hemoglobin, and lymphocyte count) and clinical variables (ascites, pain, and vomiting) were recorded at baseline. A Karnofsky Performance Status (KPS) was also determined. RESULTS Sites of primary cancer were the stomach in 31.6%, ovaries in 27.6%, colorectum in 19.7%, and other in 21.1%. At baseline patients had abnormally low values: 55.3% had a body mass index no greater than 20.0 kg/m2, 40.4% had a serum albumin level lower than 3.0 g/dL, 55.7% had a lymphocyte count no higher than 1200/mm3, 54.6% had a cholesterol level lower than 160 mg/dL, and 63.1% had a CHE level lower than 5400 U/L. Pain, ascites, vomiting, and a KPS score no higher than 40 were observed in 44.1%, 55.3%, 76.3%, and 51.3% of patients, respectively. Survival ranged from 6 to 1269 d (median 45 d). Patients with a KPS score no higher than 40 had shorter survival than did patients with a KPS score of at least 50 (median 28.5 versus 81, P = 0.0001). Multivariate analysis (R2 = 0.152 for the entire model) indicated that KPS (P = 0.01) and CHE (P = 0.034) were significant predictors of survival. Moreover, three different combinations of selected clinical and laboratory variables identified patients who survived fewer than 60 d (high specificity). CONCLUSIONS Time of survival widely varied among terminal cancer patients; identification of predictive factors could help to draw up guidelines to improve indications for HPN. In this study, traditional predictors (KPS, albumin, pain, and vomiting) and CHE level appeared to be a useful survival predictor index in incurable patients with peritoneal carcinosis on HPN.
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Affiliation(s)
- Lidia Santarpia
- Internal Medicine and Clinical Nutrition, Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
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Jonkers-Schuitema CF, Sauerwein HP, Tas TA. Can home parenteral nutrition be provided by non-specialized centres?: The Dutch experience. Clin Nutr 2005; 24:526-7; author reply 528. [PMID: 15998553 DOI: 10.1016/j.clnu.2005.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Accepted: 04/09/2005] [Indexed: 10/25/2022]
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Cherny NI. Taking care of the terminally ill cancer patient: management of gastrointestinal symptoms in patients with advanced cancer. Ann Oncol 2005; 15 Suppl 4:iv205-13. [PMID: 15477309 DOI: 10.1093/annonc/mdh928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- N I Cherny
- Pain Palliative Medicine Service, Department of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
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Duerksen DR, Ting E, Thomson P, McCurdy K, Linscer J, Larsen-Celhar S, Brennenstuhl E. Is there a role for TPN in terminally ill patients with bowel obstruction? Nutrition 2004; 20:760-3. [PMID: 15325683 DOI: 10.1016/j.nut.2004.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE There is controversy regarding the use of total parenteral nutrition (TPN) in individuals with metastatic malignancies. The objective of this study was to determine whether a subgroup of patients with intestinal obstruction would benefit from support with TPN. METHODS A retrospective review of patients considered for home TPN by a regionalized home TPN program was conducted RESULTS Over a 6-y period, nine patients with primary gastrointestinal malignancy and metastatic intestinal obstruction were identified. There was a variable survival rate of 27 to 433 d. Survival rate longer than 60 d was noted in six of nine patients. Most patients had no direct TPN-related complications, but one patient had significant morbidity related to venous thrombosis and line sepsis. There were no nutritional predictors of prolonged survival rate with TPN. TPN was continued until death in six of nine patients. CONCLUSION Patients with small bowel obstruction and metastatic malignancy may benefit from TPN as demonstrated by prolonged survival rate longer than 60 d. There are no clear predictors of who will benefit from TPN, and each case should be considered individually, with the potential risks and benefits discussed with the family and primary caregivers. Future studies should address the effect of TPN on quality of life of the patient and their caregivers.
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Lesage P, Portenoy RK. Ethical challenges in the care of patients with serious illness. PAIN MEDICINE 2004; 2:121-30. [PMID: 15102301 DOI: 10.1046/j.1526-4637.2001.002002121.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The approach to management of patients with advanced disease and serious illness has been strongly influenced by advances in science and technology, the increasing role of ethics in clinical practice, and the recognition of new rights and social changes. At the present time, decision making is modulated by ethical and legal considerations. One of the challenges of clinical practice is to maintain the delicate balance between the technical aspects and the humanistic aspects of care. For the resolution of this challenge, this article proposes an ethical and legal framework that considers the goals of care and respects the basic values of autonomy, beneficence, and justice. Ethical and legal principles complement sound medical practice but should never replace it. At all times, clarification of the medical situation, good communication, and information about state of the art treatment proposals are essential. In the context of advanced illness, the most prominent issues relate to decision making, justice, and research.
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Affiliation(s)
- P Lesage
- Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York 10003, USA.
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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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Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 2002. [PMID: 11841046 DOI: 10.1177/0148607102026001011] [Citation(s) in RCA: 468] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Affiliation(s)
- J Cohen
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Abstract
Most terminally ill patients experience symptoms that require treatment as death approaches. The most common symptoms are pain (5% to 51%), dyspnea (28%), oral and respiratory secretions (25%), nausea and vomiting (10% to 14%), confusion (10%), myoclonus (12%), and bowel and bladder problems (over 20%). These symptoms can be well controlled in up to 90% of individuals with appropriate communication; emotional, spiritual, and social support; noninvasive clinical evaluation; and therapy focused on symptom palliation. Types of drugs that are important in symptom control include opioids, co-analgesics, anxiolytics, and anticholinergics. To be effective, these medications must be readily available for use and often need to be given by a non-oral route.
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Affiliation(s)
- J D Cowan
- Palliative Medicine of East Tennessee, 1915 White Avenue, Knoxville, TN 37916, USA.
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Ortiz JS, Ordóñez González J. Nutrición parenteral y cuidados paliativos. Med Clin (Barc) 2000. [DOI: 10.1016/s0025-7753(00)71381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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