Clinical significance of weight changes at diagnosis in solid tumours.

Purpose: Weight changes occur throughout the cancer trajectory. Most research has focused on changes during or after treatment, so clinical significance of change at diagnosis remains unclear. This study aimed to determine prevalence, predictors and prognostic significance of weight changes at diagnosis in outpatients with solid tumours presenting to a tertiary academic medical centre.

Serum C-reactive protein is an important and powerful prognostic biomarker in most adult solid tumors.

Introduction: Prognostication in cancer is challenging and inaccurate. C-Reactive Protein (CRP), a cheap and sensitive marker of inflammation may help. This study investigated the relationship between CRP and prognosis in a large cohort of solid tumors with mixed cancer diagnoses and stages.

The Effect of the Pain Symptom Cluster on Performance in Women Diagnosed with Advanced Breast Cancer: The Mediating Role of the Psychoneurological Symptom Cluster.

Background: Pain, depression, anxiety, sleep disturbances, and constipation were reported in different symptom clusters at different stages of breast cancer. Managing symptom clusters rather than individual symptoms can improve performance status.

Aim: The study examined the effect of pain symptom cluster (pain and constipation) on performance when mediated by the psychoneurological symptom cluster (depression, anxiety, and sleep disturbances) using age as a moderator.

Palliative Medicine Family Conferences Reduce Spokesperson Distress and Enhance Communication in Advanced Cancer.

Introduction: Family conferences (FCs) may be important in communication. There is limited evidence about their value in palliative medicine. We examined specific information needs of patient-identified spokespersons (SP) and if the needs were met by a subsequent FC.

Symptoms, Quality of Life, and Daily Activities in People With Newly Diagnosed Solid Tumors Presenting to a Medical Oncologist.

Introduction: Symptom and Quality of Life (QOL) data are important patient reported outcomes. Early identification of these is critical for appropriate interventions. Data collection may be helped by modern information technology.

Single-Dose Fluconazole Therapy for Oral Thrush in Hospice and Palliative Medicine Patients.

Background: Oral thrush is a common fungal infection of the mouth experienced by palliative medicine and hospice patients who have advanced cancer. Individuals often experience distressing symptoms that affect their oral intake with most regimens adding to pill burden. This is an open-label prospective observational study to assess the efficacy of a single-dose fluconazole 150 mg for oral thrush.

Underrecognition of Malnutrition in Advanced Cancer: The Role of the Dietitian and Clinical Practice Variations.

Introduction: Malnutrition (MN) often goes unrecognized due to ineffective screening techniques. Published standards for multidisciplinary care exist but no consensus on best nutritional assessment for hospitalized patients. Malnutrition is common in cancer and adversely affects clinical outcomes.

Should we cluster patients or symptoms? The myth of symptom clusters based on 'depression, insomnia, pain' and 'depression, fatigue, pain'.

Context: 'Depression, fatigue, pain' (DFP) and 'depression, insomnia, pain' (DIP) symptom clusters (SCs) have been proposed in cancer. These symptoms are common and co-occur, that is, they constitute clusters of patients rather than symptoms.

Objectives: The following research questions were addressed: (1) What is the frequency of co-occurrence of two symptom groups (DFP and DIP) in advanced cancer? (2) What is the degree of symptom item association within each symptom group? (3) Were either of these symptom trios associated with prognosis?

Methods: We reanalysed a symptom data set of 1000 patients with advanced cancer.

C-Reactive Protein Is an Important Biomarker for Prognosis Tumor Recurrence and Treatment Response in Adult Solid Tumors: A Systematic Review.

Purpose: A systematic literature review was done to determine the relationship between elevated CRP and prognosis in people with solid tumors. C-reactive protein (CRP) is a serum acute phase reactant and a well-established inflammatory marker. We also examined the role of CRP to predict treatment response and tumor recurrence.

Systematic bias in cancer patient-reported outcomes: symptom 'orphans' and 'champions'.

Introduction: Patient-reported outcomes are an integral part of modern healthcare. We report a comparison of symptom item content from several validated cancer instruments to that of a published checklist, and identify the important differences this revealed.

Methods: We defined orphans as any symptom not assessed in any of the six selected instruments; champions, in contrast, were present in all six.

Evidence of significant central fatigue in patients with cancer-related fatigue during repetitive elbow flexions till perceived exhaustion.

Objective: To investigate whether fatigue induced by an intermittent motor task in patients with cancer-related fatigue (CRF) is more central or peripheral.

Methods: Ten patients with CRF who were off chemo and radiation therapies and 14 age-matched healthy controls were enrolled. Participants completed a Brief Fatigue Inventory (BFI) and performed a fatigue task consisting of intermittent elbow-flexion contractions at submaximal (40% maximal voluntary contraction) intensity till self-perceived exhaustion.

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Background: Cancer pain is complex, and despite the introduction of the WHO cancer pain ladder, few studies have looked at the prevalence of adjuvant medication use in an inpatient palliative medicine unit. In this study, we evaluate the use of adjuvant pain medications in patients admitted to an inpatient palliative care unit and whether their use affects pain scores or opiate dosing.

Methods: In this retrospective observational study, patients admitted to the inpatient palliative care unit over a 3-month period with a diagnosis of cancer on opioid therapy were selected.

A prospective study of the clinical content of palliative medicine interdisciplinary team meetings.

Structured interprofessional communication should improve the structure and clarity of the plan of care. The interdisciplinary team meeting (IDTM) is an opportunity for shared information on patients' and family care needs. We report a prospective observations study of palliative medicine IDTM, which recorded the clinical issues discussed.

Cannabinoids in pain management: CB1, CB2 and non-classic receptor ligands.

Introduction: Commercially available cannabinoids are subject to psychotomimetic and addiction (cannabinomimetic) adverse effects largely through activation of the cannabinoid 1 receptor (CB1r). The available commercial cannabinoids have a narrow therapeutic index. Recently developed peripherally restricted cannabinoids, regionally administered cannabinoids, bifunctional cannabinoid ligands and cannabinoid enzyme inhibitors, endocannabinoids, which do not interact with classic cannabinoid receptors (CB1r and CB2r), cannabinoid receptor antagonists and selective CB1r agonists hold promise as analgesics.

Low 25-hydroxyvitamin D levels in people with a solid tumor cancer diagnosis: the tip of the iceberg?

Purpose: Low serum 25-hydroxyvitamin D [25(OH)D] levels have been linked to both cancer incidence and poor prognosis. The frequency of 25(OH)D tests and clinical factors associated with low levels in cancer patients are unknown.

Patients And Methods: Electronic medical records from 2006 to 2007 of 39,252 adult solid tumor patients were reviewed.

Symptoms and problem clusters in cancer and non-cancer patients in specialized palliative care-is there a difference?

Context: In clinical practice, some symptoms and problems frequently occur in combination, which may have consequences for symptom management.

Objectives: Facing a growing number of non-cancer patients in palliative care, this study aimed to differentiate symptom clusters in the non-cancer population from those in cancer patients.

Methods: Inpatient data from the German Hospice and Palliative Care Evaluation between 2007 and 2011 were used for a cluster analysis of a 16-item symptom and problem checklist.

Achieving effective control in cancer pain: a review of current guidelines.

Pain is one of the most common and distressing elements of suffering related to cancer and cancer treatment. Progress in cancer treatment means people will live longer with the sequelae of cancer and disease-directed treatments, and both the short- and long-term effects of opioid use must be considered. Skilled practitioners caring for individuals with cancer help to alleviate cancer-related pain by using the World Health Organization (WHO) step-wise approach to pain management as well as recently updated national and international guidelines.

Efficacy and safety of a six-hour continuous overlap method for converting intravenous to transdermal fentanyl in cancer pain.

Context: Managing cancer pain often requires opioid medications, such as fentanyl, which is frequently initiated parenterally, and then converted to transdermal form. Little evidence exists to guide this conversion.

Objectives: To observe the efficacy and safety of a six-hour continuous overlap method for converting intravenous fentanyl (IVF) to transdermal fentanyl (TF) in patients with cancer pain.

Nonconvulsive status epilepticus in a palliative care unit: when delirium is a seizure.

The search for an underlying cause of altered mental status not uncommonly becomes more challenging in the hospice and palliative care setting. Due to multiple coexisting conditions that affect mental status and shifting goals of care, discerning that single cause in this venue can become frustrating and even nonbeneficial at times. We present a case of nonconvulsive status epilepticus (NCSE), which multiple reports have shown to be a rarely contemplated cause of impaired consciousness.

Connected health: cancer symptom and quality-of-life assessment using a tablet computer: a pilot study.

Incorporation of tablet computers (TCs) into patient assessment may facilitate safe and secure data collection. We evaluated the usefulness and acceptability of a TC as an electronic self-report symptom assessment instrument. Research Electronic Data Capture Web-based application supported data capture.

Nausea and vomiting in advanced cancer.

Nausea and vomiting are very common symptoms in cancer both treatment and non-treatment related. Many complications of advanced cancer such as gastroparesis, bowel and outlet obstructions, and brain tumors may have nausea and vomiting or either symptom alone. In a non-obstructed situation, nausea may be more difficult to manage and is more objectionable to patients.

The care of the actively dying in an academic medical center: a survey of registered nurses' professional capability and comfort.

Background: Care of the dying is a significant component of nursing practice particularly in hospitals. Nurses who work in certain areas like oncology, intensive care unit (ICU) face the care of the dying, more so than other units.

Objectives: The survey was conducted to assess nurses' self-perception of their professional capability and comfort in the care of the actively dying.