Pain and palliative care:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
1996
|
| Series: | Hematology, oncology clinics of North America
10,1 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | X, 292 S. Ill., graph. Darst. |
Staff View
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| adam_text | PAIN AND PALLIATIVE CARE
CONTENTS
Preface xi
Nathan I. Cherny and Kathleen M. Foley
Palliative Medicine and the Medical Oncologist: Defining the
Purview of Care 1
Nathan I. Cherny and Raphael Catane
The relationship between palliative and primary therapies for the
cancer patient and the role of the medical oncologist in the provi¬
sion of palliative care are reviewed. Shortcomings in the prevail¬
ing situation are identified, and strategies for future initiatives
are suggested.
Symptom Assessment 21
Jane M. Ingham and Russell K. Portenoy
Symptom assessment and management are integral to the care of
patients with cancer. This article describes a practical approach
to the assessment of the symptoms experienced by cancer patients
and discusses the measurement of symptoms in the research set¬
ting.
Pain and Symptom Control: Patient Rights and Physician
Responsibilities 41
Ezekiel J. Emanuel
Patients with advanced cancer have a fundamental right to ade¬
quate symptom control. In order to secure this right, the treating
clinicians take on a set of responsibilities. This article explores
§ HEMATOLCXSY/ONCDUXSY CLINICS OF NORTH AMERICA
VOLUME 10 • NUMBER 1 • FEBRUARY 1996 vii
this right with specific reference to palliative care, experimental
therapies, and physician assisted suicide or euthanasia.
Clinicopathologic Correlates of Common Cancer Pain
Syndromes 57
Augusto Caraceni
Cancer pain syndromes are defined by the association of particu¬
lar pain characteristics and physical signs with specific compli¬
cations of the underlying disease or its treatment. Specific
syndromes may be associated with distinct causes, pathophysio
logical conditions, and prognostic and therapeutic implications.
This article reviews common cancer pain syndromes and their
clinical and pathologic features.
Nonopioid and Opioid Analgesic Pharmacotherapy of
Cancer Pain 79
Nathan I. Cherny and Kathleen M. Foley
Analgesic pharmacotherapy with nonopioid and opioid analgesic
agents is the mainstay of treatment for patients with cancer pain.
This article reviews the clinical pharmacology of these agents and
presents practical guidelines for drug selection, dosing, schedul¬
ing, and the management of adverse effects.
Adjuvant Analgesic Agents 103
Russell K. Portenoy
The adjuvant analgesics comprise a diverse group of drugs that
have primary indications other than pain but are analgesic in
selected circumstances. In the cancer population, these drugs
usually are considered if opioid therapy has failed to yield a
favorable balance between analgesic effects and side effects or if
pain becomes associated with a co morbid condition that may be
amenable to the adjuvant. Adjuvant analgesics are used most
often to treat refractory neuropathic pain, multifocal bone pain,
and pain due to malignant bowel obstruction. The appropriate
use of these drugs requires a working knowledge of their phar¬
macology and a detailed understanding of the patient and the
pain syndrome.
Invasive Techniques in the Management of Cancer Pain 121
Nathan I. Cherny, Ehud Arbit, and Subash Jain
Patients who are unable to achieve adequate analgesia without
excessive adverse effects may benefit from invasive anesthetic
and neurosurgical interventions. This article reviews the proce¬
dures commonly used and offers practical guidelines for interven¬
tion selection in a range of clinical situations.
Viii CONTENTS
Psychological Approaches to the Management of Pain in
Patients with Advanced Cancer 139
Matthew Loscalzo
Cancer related pain and associated distress significantly challenge
the physician and the mental well being of advanced cancer pa¬
tients and their families. Patients frequently manifest symptoms
and maladaptive behaviors that require specialized interventions
to restore a sense of focus and control. A comprehensive psycho
behavioral approach integrating traditional supportive psycho
therapies and cognitive behavioral interventions is uniquely
suited to address the most common psychological and emotional
problems of advanced cancer patients and their families.
Management of Dyspnea and Cough in Patients with Cancer 157
Deborah J. Dudgeon and Susan Rosenthal
Dyspnea and cough are very common symptoms that can seri¬
ously affect the quality of life of patients with cancer. This article
reviews their epidemiology, the clinical syndromes that are com¬
mon in cancer, and the indications and limitations of the available
therapeutic approaches for the treatment of these symptoms.
Integrating Medical and Surgical Treatments in
Gastrointestinal, Genitourinary, and Biliary Obstruction
in Patients with Cancer 173
Robin L. Fainsinger
This article discusses therapeutic options for the relief of symp¬
toms such as pain, nausea, and vomiting in patients with bowel
obstruction due to advanced cancer. Management of malignant
ureteric obstruction is reviewed as well. Finally, several guide¬
lines for the palliation of malignant biliary obstruction are of¬
fered.
Anorexia and Cachexia, Asthenia, and Lethargy 189
Sharon Watanabe and Eduardo Bruera
Anorexia cachexia, asthenia, and lethargy are among the most
common clinical manifestations of cancer. This article reviews
the prevalence, pathophysiology, assessment, management, and
research taking place for each of these phenomena.
Nausea and Vomiting in Patients with Cancer 207
Ivan Lichter
This article gives an account of the mechanisms of emesis and
the neuropharmacology of antiemetics as a basis for the selection
of the most appropriate medication for the control of nausea and
vomiting in cancer patients. This approach requires that the cause
CONTENTS ix
of the nausea and vomiting be established. The antiemetic man¬
agement process aims to block neurotransmission of the emetic
stimulus at a point in its particular pathway to the vomiting
center. The most potent neurotransmitter antagonist with action
at that site will be the drug of choice. The selection of antiemetics
for emesis caused by the disease process, drugs used in the
treatment of associated symptoms, and treatment with chemo¬
therapy and radiotherapy are considered.
Nutrition Therapy for the Cancer Patient 221
Moshe Shike
Patients with cancer may have decreased food intake and malab
sorption or metabolic derangements. These result in malnutrition
in the form of calorie protein deficits or specific nutrient deficits.
Nutritional therapies aimed at preventing or correcting malnutri¬
tion in patients with cancer include oral diet, enteral nutrition,
and parenteral nutrition.
Psychiatric Emergencies in Terminally 111 Cancer Patients 235
Andrew J. Roth and William Breitbart
The most common psychiatric emergencies observed in patients
with cancer are severe anxiety, delirium, depression, and suicidal
inclinations/attempts. Patients with advanced cancer are at a
particular risk, and treating oncologists need to be familiar with
management strategies. This article presents strategies for the
identification, assessment, and management of these emergencies.
Guidelines in the Care of the Dying Cancer Patient 261
Nathan I. Cherny, Nessa Coyle, and Kathleen M. Foley
Approximately 50% of cancer patients will ultimately die of their
disease. Based on a review of the existing literature, this article
presents guidelines to assist the medical oncologist in the care of
patients who are dying.
Index 287
Subscription Information Inside back cover
X CONTENTS
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