Thromboprophylaxis in patients receiving inpatient palliative care: a survey of present p…

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The effect of in-patient chest physiotherapy in lung cancer patients.

Support Care Cancer. 2010 Mar;18(3):351-8

Authors: Ozalevli S, Ilgin D, Kul Karaali H, Bulac S, Akkoclu A

GOALS OF WORK: The aim of our study was to investigate the effect of the in-patient chest physiotherapy (ICP) in patients with lung cancer. PATIENTS AND METHODS: Eighteen patients with stage IIIA, IIIB, or IV lung cancer (3 females and 15 males) were included. The demographic characteristics and the clinical history of the patients were recorded. Pain (visual analog scale), pulmonary function (pulmonary function test), functional capacity (6-min walking test, Karnofsky performance status (KPS) scale), and health-related quality of life (Nottingham Health Profile (NHP)) parameters were evaluated. The ICP program, including breathing control, breathing exercises, relaxation training, upper and lower extremity exercises, mobilization, and transcutaneous nerve stimulation, was designed to meet each patient's individual needs. MAIN RESULTS: After the exercise program, there was a significant decrease in the severity of the dyspnea, fatigue, and pain symptoms (p < 0.05), improvement in the physical mobility, pain, energy, emotional status and sleep subcategories of the NHP (p < or = 0.05), and increase in the 6-min walking distance (75 +/- 15.95 m, p = 0.003). However, pulmonary function test results and KPS scores did not show statistically significant changes (p > 0.05). CONCLUSIONS: ICP programs may be beneficial to lung cancer patients by reducing respiratory symptoms, pain, and improving health-related quality of life and exercise capacity. For this reason, the results of this study suggest that ICP programs, which are prepared by taking the individual requirements of lung cancer patients, should be placed in the treatment of the lung cancer.

PMID: 19471973 [PubMed - indexed for MEDLINE]

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Use of oxygen and opioids in the palliation of dyspnoea in hypoxic and non-hypoxic palliative care patients: a prospective study.

Support Care Cancer. 2009 Apr;17(4):367-77

Authors: Clemens KE, Quednau I, Klaschik E

BACKGROUND: Dyspnoea is a complex experience of the body and the mind. Whereas the effects of opioids on dyspnoea in advanced disease have been the focus of studies for management of dyspnoea in palliative medicine, the role of oxygen is still unclear. The effects of symptomatic oxygen and opioid treatment on ventilation and palliation of dyspnoea in hypoxic (H) and non-hypoxic (NH) palliative care patients were assessed and compared. METHODS: In a prospective, non-randomised study, 46 patients with mild to severe dyspnoea were included. Transcutaneous measurement (earlobe sensor) of carbon dioxide partial pressure (tcpaCO2), pulse oximetry oxygen saturation (SaO2) and pulse frequency (PF) were monitored with SenTec digital monitor. Compared was: baseline data of the continuously documented respiratory parameters for about 15 min in patients breathing room air at admission, 60 min during nasal O2 insufflation, and 30, 90 and 120 min after the first opioid application and without O2 insufflation. RESULTS: Whereas opioid application resulted in a significant decrease in the intensity of dyspnoea and respiratory rate, during the nasal O2 insufflation (4 l/min), there was no significant decrease in the intensity of dyspnoea neither in H (P = 0.564) nor in NH (P = 0.096) patients. There was no evidence of a significant correlation between the intensity of dyspnoea and oxygen saturation. The Spearman rank correlation in NH patients was -0.080 (P = 0.686) and in H patients P = 0.296 (P = 0.233). No significant differences between the groups of hypoxic and non-hypoxic patients with regard to tcpaCO2 increase (P = 0.075 NH; P = 0.346 H) or SaO2 decrease after opioid application (P = 0.077) were found. CONCLUSIONS: In this study, opioids worked significantly better than oxygen in reducing the intensity of dyspnoea even in hypoxic patients. There was no correlation between intensity of dyspnoea and oxygen saturation in H and NH patients. Oxygen should be seen as a pharmacological agent and not be given based on intuitive assumption of benefit.

PMID: 18719948 [PubMed - indexed for MEDLINE]

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It appears to be safe to start chemotherapy on the day of implantation through subcutaneous venous port catheters in inpatient setting.

Support Care Cancer. 2009 Apr;17(4):399-403

Authors: Ozdemir NY, Abali H, Oksüzo?lu B, Budako?lu B, Akmangit I, Zengin N

GOALS: It is generally recommended to wait for at least 24 h before starting chemotherapy after implanting venous port catheters (VPC). Our aim was to evaluate whether it is safe to start chemotherapy on the day of implantation. PATIENTS AND METHODS: One hundred eighty patients who had to be given chemotherapy on the day of VPC implantation at our institution from June 2005 to April 2007 were included. MAIN RESULTS: Of patients, 122 were male (67.8%) and median age was 55 years. Majority (133, 72.8%) had colon and gastric adenocancer. Median time to chemotherapy onset from VPC implantation was 102 min (minimum-maximum, 12-402). One hundred sixty-four (91.1%) received prolonged chemotherapy infusions beyond 48 h. No life-threatening acute complications like pneumothorax and hemothorax developed. In one patient extravasation (empty saline extravasation secondary to wrong insertion of the needle), in 17 (9.4%) pain, and in 41 (22.8%) minor bleeding as echymosis were seen. Thrombosis developed in 11 (6.1%). Reasons for VPC removal were thrombosis (2), sepsis (2), cellulitis (1), skin dehiscence (1), and patient will (1). CONCLUSION: Chemotherapy administration immediately after VPC implantation appears safe without increased acute and chronic complications in inpatient setting.

PMID: 18762993 [PubMed - indexed for MEDLINE]

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Patients’ perceptions of having a central venous catheter or a totally implantable subcutaneous port system-results from a randomised study in acute leukaemia.

Support Care Cancer. 2009 Feb;17(2):137-43

Authors: Johansson E, Engervall P, Björvell H, Hast R, Björkholm M

GOALS OF WORK: The selection process of type of central venous access device (CVAD) in patients with acute leukaemia (AL) is generally based on appropriate catheter capacity/function and risk of complications in relation to the planned length of therapy. Advantages and disadvantages of the CVAD from the patient’s perspective should also be important parts in the selection of type of device. Perceptions on having a CVAD were thus analysed in a series of adult patients with AL included in a prospective randomised study evaluating the use of a double lumen totally implantable subcutaneous port system (PORT) or a double lumen central venous catheter (CVC) regarding survival time and complication rate. MATERIALS AND METHODS: Perceptions were registered in 32 patients (median age 68 years, range 24-83 years) on three occasions (T1; the day after placement, T2; 3 weeks after placement and T3 after 12 weeks and/or when the CVAD was removed) with the use of two study specific questionnaires. MAIN RESULTS: Overall, many patients reported minor catheter related discomfort, feelings of anxiety and restrictions. Half of the patients (6/11) who experienced a local bleeding after CVAD insertion described the placement procedure as unpleasant. More patients in the CVC group compared with the PORT group stated that they thought of having a CVAD (T3; p = 0.02) and that the CVAD interfered when dressing themselves (T2; p = 0.02 and T3; 0.04) or taking a shower (T3; p = 0.009). CONCLUSION: Our findings support the view that the PORT is less restrictive in daily life than the CVC.

PMID: 18449573 [PubMed - indexed for MEDLINE]

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Oral moxifloxacin or intravenous ceftriaxone for the treatment of low-risk neutropenic fever in cancer patients suitable for early hospital discharge.

Support Care Cancer. 2008 Sep;16(9):1017-23

Authors: Sebban C, Dussart S, Fuhrmann C, Ghesquieres H, Rodrigues I, Geoffrois L, Devaux Y, Lancry L, Chvetzoff G, Bachelot T, Chelghoum M, Biron P

GOALS OF WORK: Patients with low-risk neutropenic fever as defined by the Multinational Association of Supportive Care in Cancer (MASCC) score might benefit from ambulatory treatment. Optimal management remains to be clearly defined, and new oral antibiotics need to be evaluated in this setting. MATERIALS AND METHODS: Cancer patients with febrile neutropenia and a favorable MASCC score were randomized between oral moxifloxacin and intravenous ceftriaxone. All were fit for early hospital discharge. The global success rate was related to the efficacy of monotherapy, as well as to the success of ambulatory monitoring. MAIN RESULTS: The trial was closed prematurely because of low accrual. Ninety-six patients were included (47 in the ceftriaxone arm and 49 in the moxifloxacin arm). A total of 65% were women, 30.2% had lymphoma, 34.4% had metastatic, and 35.4% had non-metastatic solid tumors. The success rates of home antibiotics were 73.9% and 79.2% for ceftriaxone and moxifloxacin, respectively. Seven patients were not discharged, and 14 required re-hospitalization. There were 17% of microbiologically documented infections that were, in most cases, susceptible to oral monotherapy. CONCLUSIONS: These results suggest that MASCC is a valid and useful tool to select patients for ambulatory treatments and that oral moxifloxacin monotherapy is safe and effective for the outpatient treatment of cancer patients with low-risk neutropenic fever.

PMID: 18197434 [PubMed - indexed for MEDLINE]

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Pulmonary MRI–a new approach for the evaluation of febrile neutropenic patients with malignancies.

Support Care Cancer. 2008 Jun;16(6):599-606

Authors: Rieger C, Herzog P, Eibel R, Fiegl M, Ostermann H

GOALS OF WORK: Immunocompromised patients with malignant diseases often suffer from pulmonary infections. Early detection of these life-threatening infections is crucial to start effective treatment. The gold standard for the diagnosis of these disorders is high-resolution computed tomography (HR-CT) of the chest. This method, however, has limitations, for instance, in the discrimination of early interstitial infiltrates and the use of X-rays. We conducted a study to determine the feasibility and sensitivity of magnetic resonance imaging (MRI) of the lung compared to HR-CT in immunocompromised patients with persistent fever in neutropenia and suspected pneumonia. MATERIALS AND METHODS: Between January 2003 and July 2004, 50 consecutive neutropenic patients with fever of unknown origin and negative chest X-ray were examined with HR-CT of the lungs. Patients with pulmonary infiltrates were further examined with MRI of the chest within 24 h after HR-CT using a specific lung protocol. In addition, microbiological testing was performed for the characterization of the causative pathogen. RESULTS: Of 50 patients, 35 had pulmonary infiltration according to HR-CT; these were examined with MRI of the lungs. MRI showed a high correlation (91%) with the findings in HR-CT. Both HR-CT and MRI were feasible in 94% of the examined patients. In 12 of 35 patients, fungal pathogens were identified in microbiological testing. CONCLUSIONS: MRI of the lungs is feasible in neutropenic patients with suspected pulmonary infection. Compared to HR-CT, MRI displays a high sensitivity in the detection of pulmonary infiltrates. MRI offers the opportunity of follow-up examinations without repeated X-ray exposure to the patient.

PMID: 17943326 [PubMed - indexed for MEDLINE]

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Prophylactic anti-coagulation in cancer palliative care: a prospective randomised study.

Support Care Cancer. 2008 Jul;16(7):847-52

Authors: Weber C, Merminod T, Herrmann FR, Zulian GB

GOALS: The objective of this study was to determine utility of prophylactic anti-coagulation in cancer patients hospitalised for palliative care in a specialised centre. MATERIALS AND METHODS: Prospective 1:1 open randomised study was designed. Twenty patients aged 55 to 88 years with advanced cancer and an estimated life expectancy of less than 6 months were assigned to either receive treatment with 2,850/3,800 U (<70/>70 kg) of daily subcutaneous nadroparin or no treatment. Suspicion of venous thrombo-embolism (deep vein thrombosis and pulmonary embolism) was confirmed by echo-Doppler examination of the lower limbs and/or by spiral computed tomography scan of the lungs. Bleeding episodes were recorded. Platelet count was measured on days 7 and 14. Survival time from study entry was determined. MAIN RESULTS: One venous thrombo-embolism and one major bleeding occurred in the group receiving nadroparin, whereas two minor bleedings occurred in the control group. At 3 months, nine of ten participants had died in the control group vs five of ten in the group receiving nadroparin (P = 0.141). Five participants could be discharged home (P = 0.141). CONCLUSIONS: Decision to administer prophylactic nadroparin in hospitalised cancer patients under palliative care remains a challenge. Better mobility score at admission and the likelihood to be discharged home may be useful for practical purposes. The observation of a potential influence of prophylactic nadroparin on survival deserves further studies.

PMID: 17940809 [PubMed - indexed for MEDLINE]

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Prophylaxis of catheter-related venous thrombosis in cancer patients.

Support Care Cancer. 2008 Jul;16(7):787-90

Authors: Karthaus M

BACKGROUND: The use of indwelling central venous catheters (CVCs) for chemotherapy delivery is common practice in cancer patients. Central venous lines facilitate ease of blood drawing along with administration of blood products and various other therapies. Significant risks, however, include infection and catheter-related thrombosis. Several attempts have been investigated to reduce CVC-associated thrombosis, in particular anticoagulation strategies. Given the lack of clear efficacy, there is at present no recommendation for the use of prophylactic anti-coagulation in patients with solid malignancy and an indwelling CVC. MATERIALS AND METHODS: This paper reviews recent given recommendations based on controlled trials.

PMID: 18274788 [PubMed - indexed for MEDLINE]

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The management of dyspnea in cancer patients: a systematic review.

Support Care Cancer. 2008 Apr;16(4):329-37

Authors: Viola R, Kiteley C, Lloyd NS, Mackay JA, Wilson J, Wong RK,

GOALS OF WORK: The goal of the study is to evaluate the effectiveness of four drug classes (opioids, phenothiazines, benzodiazepines, and systemic corticosteroids) for relieving dyspnea experienced by advanced cancer patients. MATERIALS AND METHODS: A systematic literature review was conducted to July 2006. Search sources included MEDLINE, EMBASE, HealthSTAR, CINAHL, and the Cochrane Library. Four reviewers selected evidence using predefined criteria: controlled trials not limited to cancer and involving the specified drug classes for dyspnea treatment. MAIN RESULTS: Three systematic reviews, one with meta-analysis, two practice guidelines, and 28 controlled trials were identified. Most examined the effect of opioids, generally morphine, on dyspnea. Although the results of individual trials were mixed, the systematic review with meta-analysis detected a significant benefit for dyspnea with systemic opioids; two small placebo-controlled trials in cancer patients found systemic morphine reduced dyspnea, and dihydrocodeine also significantly reduced dyspnea in four placebo-controlled trials. Nebulized morphine was not effective in controlling dyspnea in any study or the meta-analysis. No controlled trials examined systemic corticosteroids in the treatment of cancer patients, and of the other non-opioid drugs examined, only oral promethazine, a phenothiazine, showed some benefit in the relief of dyspnea. Studies varied in methodological quality. CONCLUSIONS: Systemic opioids, administered orally or parenterally, can be used to manage dyspnea in cancer patients. Oral promethazine may also be used, as a second-line agent if systemic opioids cannot be used or in addition to systemic opioids. Nebulized morphine, prochlorperazine, and benzodiazepines are not recommended for the treatment of dyspnea, and promethazine must not be used parenterally.

PMID: 18214551 [PubMed - indexed for MEDLINE]

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Patients’ perceptions of having a central venous catheter or a totally implantable subcutaneous port system-results from a randomised study in acute leukaemia.

Support Care Cancer. 2008 May 1;

Authors: Johansson E, Engervall P, Björvell H, Hast R, Björkholm M

GOALS OF WORK: The selection process of type of central venous access device (CVAD) in patients with acute leukaemia (AL) is generally based on appropriate catheter capacity/function and risk of complications in relation to the planned length of therapy. Advantages and disadvantages of the CVAD from the patient’s perspective should also be important parts in the selection of type of device. Perceptions on having a CVAD were thus analysed in a series of adult patients with AL included in a prospective randomised study evaluating the use of a double lumen totally implantable subcutaneous port system (PORT) or a double lumen central venous catheter (CVC) regarding survival time and complication rate. MATERIALS AND METHODS: Perceptions were registered in 32 patients (median age 68 years, range 24-83 years) on three occasions (T1; the day after placement, T2; 3 weeks after placement and T3 after 12 weeks and/or when the CVAD was removed) with the use of two study specific questionnaires. MAIN RESULTS: Overall, many patients reported minor catheter related discomfort, feelings of anxiety and restrictions. Half of the patients (6/11) who experienced a local bleeding after CVAD insertion described the placement procedure as unpleasant. More patients in the CVC group compared with the PORT group stated that they thought of having a CVAD (T3; p = 0.02) and that the CVAD interfered when dressing themselves (T2; p = 0.02 and T3; 0.04) or taking a shower (T3; p = 0.009). CONCLUSION: Our findings support the view that the PORT is less restrictive in daily life than the CVC.

PMID: 18449573 [PubMed - as supplied by publisher]

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