Modern management of cancer-related intestinal obstruction.

Malignant-associated bowel obstruction remains a common and perplexing problem for patients with advanced gynecologic and gastrointestinal malignancies. The ability to locate and define its cause preoperatively has improved with the advent of computed tomography. Initial clinical experience with half-Fourier acquisition single-shot turbo spin-echo magnetic resonance imaging (HASTE MRI) and virtual colonoscopy is exciting.

Modern management of the cancer anorexia-cachexia syndrome.

The cancer anorexia-cachexia syndrome is common, occurring in 80% of patients with advanced-stage cancer, and it is one of the most frequent causes of death in patients with cancer. It is a complex problem involving abnormalities in protein, carbohydrate, and fat metabolism. Tumors have both direct and indirect effects that result in anorexia and weight loss.

Hydromorphone: pharmacology and clinical applications in cancer patients.

Hydromorphone is a more potent opioid analgesic than morphine and is used for moderate to severe pain. It can be administered by injection, by infusion, by mouth, and rectally. Oral bioavailability is low.

Methadone for relief of cancer pain: a review of pharmacokinetics, pharmacodynamics, drug interactions and protocols of administration.

Methadone, a synthetic opioid, has unique pharmacodynamics and pharmacokinetics, which contribute to its unique ability to relieve pain unresponsive to other potent opiates and its unique dosing and drug interactions. Several guidelines of administration have been established. Physicians who are involved in pain management should have a fundamental understanding of methadone's unique properties.

The gastrointestinal symptoms of advanced cancer.

The commonest gastrointestinal (GI) symptoms in advanced cancer are reviewed with reference to definition, pathophysiology, etiology, prevalence, severity, and management. Observation or reporting of such symptoms must lead to consideration of the multi-faceted pathophysiology. Careful assessment and an analytical detailed approach are the keystones of effective management.

Symptom control in the pregnant cancer patient.

While much attention has been devoted to cytotoxic drugs and radiation therapy in the pregnant cancer patient, the drugs used for management of symptoms and complications related to cancer during pregnancy have been overlooked. There is substantial overlap between the symptoms of cancer and cancer management and the symptoms related to pregnancy. The mainstay of symptom management is drug therapy and the potential for a drug to be embryotoxic or teratogenic depends on when it is given.

Modern management of the cancer anorexia-cachexia syndrome.

The cancer anorexia-cachexia syndrome is common, occurring in 80% of patients with advanced-stage cancer, and it is one of the most frequent causes of death in patients with cancer. It is a complex problem involving abnormalities in protein, carbohydrate, and fat metabolism. Tumors have both direct and indirect effects that result in anorexia and weight loss.

Communication in advanced disease.

Communication between physician, patient, and family becomes intense and fraught with problems in the setting of advanced disease. Protocols for end-of-life communication have been developed by various authors, but they have focused primarily on delivery of "bad news" in an individual encounter. This article addresses the need for ongoing conversation throughout the progression from life-prolonging treatment to hospice care.

Modern management of cancer-related intestinal obstruction.

Malignant associated bowel obstruction remains a common and perplexing problem for patients with advanced gynecologic and gastrointestinal malignancies. The ability to locate and define its cause preoperatively has improved with the advent of computed tomography. Initial clinical experience with half-Fourier acquisition single-shot turbo spin-echo magnetic resonance imaging (HASTE MRI) and virtual colonoscopy is exciting.

Infectious complications of advanced cancer.

We present a retrospective study of the frequency, pattern, and management of infections in advanced cancer. Three hundred ninety-three patients were admitted to an acute care palliative medicine unit in an 8-month period for evaluation and palliation of cancer-related symptoms and complications. One hundred fifteen had at least one positive bacteriological culture, and 100 of these patients were evaluable.

Treatment of nausea and vomiting in advanced cancer.

Nausea and vomiting unrelated to chemotherapy is common in advanced cancer patients. The etiology of nausea and vomiting may from evident by the pattern of vomiting, associated symptoms, review of medications and physical examination. Radiographic studies are particularly helpful if bowel obstruction is suspected or central nervous system metastases are a possibility.

Psychostimulants in supportive care.

Psychostimulant medications have been used clinically and investigated in psychiatric populations, the medically ill, cancer patients and healthy people. This article discusses the pharmacology of dextroamphetamine, methylphenidate, pemoline (and other psychostimulants such as caffeine and ephedrine), their use in general medicine and cancer care, side effects, and abuse potential. Therapeutic use in children is addressed only insofar as it illustrates facets of their use in adults.

Bioelectrical impedance, cancer nutritional assessment, and ascites.

This report describes our experience in the use of bioelectrical impedance analysis (BIA) as a method of nutritional assessment in a cancer patient with ascites. The BIA was an unreliable measure of body composition in this setting.

Psychosocial care in advanced cancer.

In palliative care, the focus is management of major symptoms and complications, and psychosocial support of the patient and family. Approaching the end of life, the patient's needs move beyond physical care to include the psychological, social, and spiritual dimensions. The main psychosocial interventions are counseling, education, and practical services directed at the needs identified by the multidimensional/multidisciplinary assessments.

Bioethics: communication and decision-making in advanced disease.

Effective communication is the cornerstone of excellence in patient care, and breakdown in communication is a common problem leading to requests for bioethics consultation. In palliative medicine, issues involving end-of-life decisions inherently involve many potential ethical concerns. Ensuring good communication among the physician, health care professionals, patient, and family will facilitate care, and avoid ethical problems.

The dying cancer patient.

Cancer patients often die with serious unrelieved symptoms causing a distressing death for them and needless added suffering for their families. Many physicians have not been trained to care for the dying patient. This chapter reviews the common symptoms and describes the methods to control them and support the patient and family through this difficult time.

The cancer anorexia-cachexia syndrome.

The cancer anorexia-cachexia syndrome is one of the most common causes of death among cancer patients and is present in 80% at death. It is a complex example of metabolic chaos effecting protein, carbohydrate, and fat metabolism. Tumors produce both direct and indirect abnormalities, resulting in anorexia and weight loss.

Common complications of advanced cancer.

Complications due to cancer and its treatment are common and increase in incidence and severity as the disease progresses. Central nervous system complications affect 15% to 20% of patients, and up to 75% have bone metastases at some point during the disease process. Endocrine abnormalities include hypercalcemia, adrenal insufficiency, and inappropriate antidiuretic syndrome.

Common symptoms in advanced cancer.

The relief of physical and psychological symptoms is an essential part of palliative care. Advanced cancer is an acute process; because the clinical picture changes rapidly, symptoms must be reassessed regularly, and a careful history is essential. Defining the relationship of the symptoms to the disease can defuse fear and encourage a sense of control in patients and their families.

Clinical evaluation in advanced cancer.

This chapter will outline a general approach to symptom assessment, using the interdisciplinary approach to pain as a model. Due to the implications of cognitive impairment for treatment compliance, consent, and caregiver burden, assessment of cognitive function will be reviewed in detail. Problem areas in assessment are identified, along with aids to improve assessment and emphasize the key contribution of the nurse.

Palliative management of dyspnea in advanced cancer.

Dyspnea is a common and devastating symptom of life-threatening disease. Approximately 90% of non-small cell lung cancer patients experience moderate to severe dyspnea by death. Currently, the pathology is ill-defined and measurement of this subjective symptom is imprecise.