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Vertebroplasty and kyphoplasty for spinal metastases.

Curr Opin Support Palliat Care. 2008 Mar;2(1):9-13

Authors: Chi JH, Gokaslan ZL

PURPOSE OF REVIEW: Pathologic fractures of the spine are extremely painful and cause significant disability and morbidity in patients suffering from metastatic cancer. Often, these patients are not candidates for open surgical procedures and cannot address mechanical instability and radiation therapy can take weeks to become effective. Minimally invasive surgical techniques have been developed over the past several years, offering a simple and effective way of managing painful pathologic fractures. RECENT FINDINGS: Vertebroplasty and kyphoplasty offer patients a minimally invasive, percutaneous procedure that dramatically reduces pain related to pathologic spinal fractures almost immediately with very low complication rates. Visual analog scale pain scores, narcotic usage and quality of life scales (SF-36) have all been shown to improve in a durable fashion for over 1 year. Also, these procedures can be performed before, after or concurrently with most radiation and chemotherapy protocols. SUMMARY: We recommend vertebroplasty or kyphoplasty in properly selected patients with painful pathologic fractures as early as possible. Newer biomaterials, which are softer than currently used cement, may offer better protection from adjacent level fracturing and lower complication rates.

PMID: 18685387 [PubMed - indexed for MEDLINE]

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Review of the evidence for the management of dyspnoea in people with chronic heart failure.

Curr Opin Support Palliat Care. 2008 Jun;2(2):84-8

Authors: Oxberry SG, Johnson MJ

PURPOSE OF REVIEW: To identify current management options for dyspnoeic people with chronic heart failure. RECENT FINDINGS: Optimization of chronic heart failure treatment is important for symptom control and survival. This review therefore includes recent advances in cardiac treatment as well as interventions directed solely at dyspnoea management although dyspnoea is rarely a primary endpoint in cardiac trials.Improved understanding of pathophysiology has led to the development of novel drugs. Currently their role, be it in disease management or symptom benefit, acute decompensation or stable disease, is unclear.Cardiac resynchronization therapy appears to be helpful for both symptom control and survival. The importance of monitoring cardiac status and fluid balance is well recognized, and may be further optimized by home telemonitoring.For dyspnoea, nonpharmacological interventions such as exercise rehabilitation or use of a fan may be helpful. There is a small evidence base for the use of opioids, but in general, pharmacological management specifically for dyspnoea remains underresearched. SUMMARY: Optimization of cardiac drugs and devices form the basis of symptom control. Novel drug agents for chronic heart failure may have some symptom benefit. Dyspnoea as a prime endpoint in chronic heart failure remains underresearched, but there is some evidence for nonpharmacological measures and opioid use.

PMID: 18685401 [PubMed - indexed for MEDLINE]

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Oxygen for relief of dyspnea: what is the evidence?

Curr Opin Support Palliat Care. 2008 Jun;2(2):89-94

Authors: Uronis HE, Abernethy AP

PURPOSE OF REVIEW: Refractory dyspnea is a common and distressing symptom complicating respiratory illness, including chronic obstructive pulmonary disease, and life-limiting illnesses in general, including cancer. Oxygen is often prescribed for relief of dyspnea and several consensus guidelines support this practice. The goal of this review is to outline the evidence for the use of oxygen for relief of dyspnea, with specific attention to situations in which oxygen is not already funded through long-term oxygen treatment guidelines (i.e., when PaO2 is >/=55 mmHg; also known as palliative oxygen). RECENT FINDINGS: Several recent systematic reviews, two focusing on people with chronic obstructive pulmonary disease and the other focusing on people with cancer, strengthen the evidence base behind the use of palliative oxygen for relief of refractory dyspnea, and support the observation that there are subgroups of people who benefit from oxygen, such as individuals with chronic obstructive pulmonary disease. SUMMARY: The data highlighted in this review support the belief that certain individuals benefit from the use of palliative oxygen but continue to suggest that definitive randomized trials are required to fully establish the benefit of palliative oxygen and to delineate characteristics predictive of benefit.

PMID: 18685402 [PubMed - indexed for MEDLINE]

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Total dyspnoea.

Curr Opin Support Palliat Care. 2008 Jun;2(2):110-3

Authors: Abernethy AP, Wheeler JL

PURPOSE OF REVIEW: To articulate a new conceptual model of breathlessness – termed total dyspnoea – which translates the well recognized total pain model to the realm of dyspnoea and addresses the patient’s experiences of this symptom in the physical, psychological, social, and spiritual domains. RECENT FINDINGS: In the past year, studies in the field of dyspnoea have explored a host of new approaches spanning pharmacological, mechanical, and behavioral strategies for symptom management and resolution. This flagship paper provides a unifying framework for considering these seemingly diverse approaches. The total dyspnoea model comprehensively defines the suffering of the individual experiencing dyspnoea, describing the patient’s experience in a broad enough manner for the model to incorporate the wide spectrum of new treatment interventions. SUMMARY: To avoid further fragmentation in clinical approaches to dyspnoea, healthcare providers need to view recent findings within the context of a coherent framework, one that places newly demonstrated interventions in the broader context of the full patient experience. This paper introduces total dyspnoea as a new paradigm that provides palliative care clinicians with an organizing structure for this complex symptom and body of evidence.

PMID: 18685406 [PubMed - indexed for MEDLINE]

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