Palliative care medicine:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2002
|
| Schriftenreihe: | Hematology, oncology clinics of North America
16,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV S., S. 511 - 773 Ill., graph. Darst. |
Internformat
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| 490 | 1 | |a Hematology, oncology clinics of North America |v 16,3 | |
| 650 | 7 | |a Palliatieve behandeling |2 gtt | |
| 650 | 4 | |a Drug Interactions | |
| 650 | 4 | |a Neoplasms |x complications | |
| 650 | 4 | |a Palliative Care | |
| 650 | 4 | |a Palliative treatment | |
| 650 | 4 | |a Terminal Care | |
| 650 | 4 | |a Terminal care | |
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Datensatz im Suchindex
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| adam_text | T l 11 Vll i: CARI. MI IJICINI
CONTENTS
Preface xiii
Paul W. Walker and Eduardo D. Bruera
Cancer Patients in Pain: Considerations for Assessing the
Whole Person 511
Dennis C. Turk, Elena S. Monarch, and Arthur D. Williams
Pain is a subjective, multidimensional experience that is influenced
by psychosocial and behavioral factors and physical pathology. As
a result, assessment of the patient who reports pain requires atten¬
tion to each contributing factor. The authors emphasize the need to
assess the person and not just the pain. Psychosocial and behavio¬
ral assessment of the cancer patient with pain should be routine.
The nature of the assessment should be determined by the timing
(ie, initial assessment, routine assessment, when there is a signifi¬
cant change in pain, and after implementation of a new treatment).
A balance must be made between the comprehensiveness of the
assessment and the patient s capacity to respond. At a minimum,
evaluation should include assessment of pain severity, location,
pattern, functional impact, and emotional status. Appropriate
assessment will assist in treatment decisions, which should, in
turn, reduce patients suffering and improve the quality of their lives.
Advances in Cancer Pain Management 527
Annette Vielhaber and Russell K. Portenoy
Although most patients with cancer pain can attain a favorable bal¬
ance between analgesia and side effects with a conventional
approach to opioid therapy, a substantial minority cannot. For
these patients, whose pain is poorly responsive to an opioid regi¬
men, alternative therapeutic strategies are needed. With a detailed
assessment, clinicians should be able to choose among the large
VOLUME 16 . NUMBER 3 • JUNE 2002 vii
and diverse group of options available and implement an approach
that improves pain relief.
The Use of Methadone for Cancer Pain 543
Carla Ripamonti and Mauro Bianchi
This article briefly summarizes the most significant data on the
pharmacology and on the clinical use of methadone. The authors
hope that the information provided in this article will help to pro¬
mote more extensive and appropriate use of methadone for the
treatment of pain in patients with advanced cancer.
Managing Dyspnea and Cough 557
Deborah J. Dudgeon
Dyspnea, like pain, is a subjective experience that incorporates
physical elements and affective components. Management of
breathlessness in patients with cancer requires expertise that
includes an understanding and assessment of the multidimensional
components of the symptom, knowledge of the pathophysiologic
mechanisms and clinical syndromes that are common in cancer,
and familiarity with the indications and limitations of the available
therapeutic approaches. Relief of breathlessness should be the goal
of treatment at all stages of cancer. Good control of dyspnea will
improve the patient s quality of life.
Fever and Sweats in the Patient with Advanced Cancer 579
Donna S. Zhukovsky
Fever and sweats are common complications of cancer and its
treatment. This article reviews potential causes and pathophysio¬
logic mechanisms of fever and sweat. Management recommenda¬
tions, consisting of primary interventions directed at contributing
causes and pathophysiologic mechanisms, and non specific pallia¬
tive measures are discussed. Optimal management is contingent
on the physician s integration of medical expertise with patient
derived goals of care.
Update on Anorexia and Cachexia 589
Florian Strasser and Eduardo D. Bruera
This article provides an outline of the progress made in the under¬
standing of the concepts and pathophysiology of anorexia and
cachexia; describes an accurate approach toward both the diagno¬
sis and impact on symptom profile, quality of life, and function;
and discusses the practical clinical management of patients suffer¬
ing from this complex syndrome.
viii CONTENTS
1st
Research into Fatigue 619
Ellen F. Manzullo and Carmen P. Escalante
Fatigue is the most common complaint of cancer patients, and it
has been reported to be the most distressing. Descriptive research
has pointed out that fatigue can be a result of the patient s cancer
and its treatment. Fatigue has also been described as a significant
symptom in cancer survivors. The National Comprehensive
Cancer Network has provided evaluation and treatment guidelines
for clinicians to use to treat fatigued cancer patients. In regards to
treatment, research is presently evaluating pharmacologic and
nonpharmacologic interventions.
Wound Care of the Advanced Cancer Patient 629
Kathryn G. Froiland
Loss of skin integrity can cause significant distress to the patient
and to the caregiver who is trying to provide comfort and promote
healing under difficult circumstances. This article discusses the
assessment and management of wounds commonly found in
oncology patients.
The Interaction of Medications Used in Palliative Care 641
Stephen A. Bernard
Medication interactions in palliative care are reviewed. An
overview of drug interactions is provided with particular attention
to these concepts as they apply in the palliative care setting. Newer
information about the role of the CYP 450 system is reviewed. The
potential for interactions with individual agents that are used in
palliative care is discussed.
Palliative Care and the Child with Cancer 657
John J. Collins
There is a growing awareness among pediatric oncologists, and a
World Health Organization imperative, to incorporate the palliative
care paradigm into the care of all children with cancer, irrespective
of geographical location. The barriers to pediatric palliative care
identified by pediatric oncologists include: lack of formal courses,
a high reliance on trial and error learning, lack of strong role mod¬
els, and lack of access to pain and palliative care service. These bar¬
riers must be overcome in order to provide effective palliative care
for children with cancer.
CONTENTS ix
Affective Disorders in Advanced Cancer 671
Mordecai Potash and William Breitbart
Recent advances in palliative care highlight the importance of
expanding our concepts of adequate palliative care beyond a focus
on pain and physical symptom control to include psychiatric, psy
chosocial, existential, and spiritual domains of care. Therefore,
skills in diagnostic assessment of psychiatric disorders and neuro
psychiatric symptoms in patients with advanced cancer are of
increasing importance to palliative care practitioners. The diagnosis
and management of depression in patients with advanced cancer
is perhaps the most difficult and important psychiatric issue
confronting palliative care practitioners. This article reviews the
prevalence, assessment, and management of depression in
advanced cancer patients.
Delirium in Patients with Advanced Cancer 701
Peter G. Lawlor and Eduardo D. Bruera
Delirium is a common neuropsychiatric complication in patients
with advanced cancer, where it often occurs as a potentially
reversible complication, and invariably occurs as a terminal event
in most patients before death. The clinical features of delirium,
such as cognitive impairment, perceptual disturbance, and agita¬
tion result in patient distress and hinder communication with
family and other caregivers. Poor recognition of this syndrome can
be attributed to ambiguity in terminology and failure to objectively
assess cognition. The ethical acceptability to pursue the end of life
sedation in the management of irreversible delirium rests on the
conduct of appropriate assessment and communication, and the
caveat of achieving symptom control as the primary intention.
Prognosis in Advanced Cancer 715
Marco Maltoni and Dino Amadori
Prognostic factors in patients with far advanced cancer enable the
physician to choose and suggest the most suitable treatment. In lit¬
erature, evidence of prognostic power has been shown for: clinical
prediction of survival, Karnofsky Performance Status, some clini¬
cal symptoms (ie, anorexia and cachexia related dyspnea,
delirium), and some biologic parameters (ie, total white blood cell
count, lymphocyte percentage, and serum albumin level). Some
authors have built and validated prognostic scores for clinical use,
and these are described in this article.
x CONTENTS
Insights from Cancer Patient Communication Research 731
Martin H.N. Tattersall, Phyllis N. Butow, and
Josephine M. Clayton
It is now accepted that doctor patient communication can have a
major influence on patient outcomes. This article reviews commu¬
nication studies that have appeared in the recent oncology litera¬
ture and have application to palliative care. Three major issues
addressed are providing information, involving the patient in
treatment decisions, and addressing emotional distress. Strategies
to promote patient understanding, participation, and adjustment
are discussed, including prompt sheets, consultation audiotapes,
summary letters, improved communication within the multi
disciplinary team, and general support. Finally, research in com¬
munication in the context of palliative care is described, which
mirrors many of the themes explored in general oncology research.
Clinical Support for Families in the Palliative Care Phase of
Hematologic or Oncologic Illness 745
Linda J. Kristjanson and Kathryn White
This article focuses on families needs for support and care when
the patient is receiving palliative care. Health care professionals
providing care to patients with hematologic or oncologic illnesses
are coming to understand that care for the family must begin at the
time of patient s diagnosis and treatment. Families who do not
receive adequate information and support in the early phases of
the patient s treatment have greater needs, less trust and con¬
fidence in the health care system, and cope more poorly in the later
stages than families who have been informed and supported
throughout the course of the illness. This article documents the
needs of families in the palliative phase of a patient s hematologic
or oncologic illness and provides empirically based recommenda¬
tions for assessment and care of the family unit.
Index 763
CONTENTS xi
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