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Dyspnea AND palliative

Tun-Yi Chen, Yih-Gang Goan, En-Kuei Tang, Yen-Chiang Tseng
RATIONALE: Bronchoscopic cryotherapy has been considered as one of the optional interventions for unresectable malignant central airway obstruction (CAO). And it provides high safety and effectiveness in airway patency re-establishment. This report describes the interventional bronchoscopic cryotherapy for a patient with CAO caused by squamous cell carcinoma of the esophagus. We display a series of dramatic change of chest radiographs before and after the intervention. PATIENT CONCERNS: A 70-year-old man with squamous cell carcinoma of the middle third of the esophagus (initial staging, pT2N0M0; stage IIB; in January 2017) underwent Video-assisted esophagectomy and reconstruction with a gastric conduit via a substernal route...
March 2019: Medicine (Baltimore)
Lonny Yarmus, Christopher Mallow, Jason Akulian, Cheng Ting Lin, David Ettinger, Russell Hales, Kinh Ranh Voong, Hans Lee, David Feller-Kopman, Roy Semaan, Kirk Seward, Momen M Wahidi
BACKGROUND: Malignant airway obstruction (MAO) occurs in 30% of patients with advanced stage lung cancer leading to debilitating dyspnea, cough and hemoptysis. Other than recanalization of the airways, these patients lack long-lasting palliative therapy. The goal of this study was to determine the safety and feasibility of local injection of paclitaxel into the airway wall with a novel microinjection catheter. METHODS: In this multicentered prospective trial, 23 patients with non-small cell lung cancer (NSCLC) and MAO from July 2014 through June 2016 were enrolled to undergo rigid bronchoscopy with recanalization, followed by injection of 1...
February 15, 2019: Chest
Hiroyuki Kawashima, Takashi Ariizumi, Tetsuro Yamagishi, Akira Ogose, Miho Ikoma, Tetsuo Hotta, Naoto Endo
BACKGROUND: Musculoskeletal sarcomas (MSSs) are rare cancers and often aggressive tumors that originate from mesenchymal tissue. Patients with advanced MSS often report difficulties with symptom burden, which can reduce their health-related quality-of-life. OBJECTIVE: The aim of this study was to describe the patterns of the physical symptoms of MSS patients in the palliative setting and to detail the palliative treatment used in the last two weeks of life. DESIGN: Retrospective study using the electronic patient records from a single institution...
February 14, 2019: Journal of Palliative Medicine
Yılmaz Bülbül, Tevfik Özlü, Sibel Arınç, Berna Akıncı Özyürek, Hülya Günbatar, Ayşegül Şentürk, Ayşe Bahadır, Melike Özçelik, Ufuk Yılmaz, Makbule Ö Akbay, Leyla Sağlam, Talat Kılıç, Gamze Kırkıl, Neslihan Özçelik, Dursun Alizoroğlu, Serap Argun Barış, Durdu M Yavşan, Hadice S Şen, Serdar Berk, Murat Acat, Gülfidan Çakmak, Perran F Yumuk, Yavuz Selim İntepe, Ümran Toru, Sibel Öktem Ayık, İlknur Başyiğit, Sibel Özkurt, Levent C Mutlu, Zehra Yaşar, Hıdır Esme, Mehmet M Erol, Özlem Oruç, Yurdanur Erdoğan, Selvi Asker, Arife Ulaş, Serhat Erol, Buğra Kerget, Ahmet Emin Erbaycu, Turgut Teke, Mehmet Beşiroğlu, Hüseyin Can, Ayşe Dallı, Fahrettin Talay
Introduction: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was to analyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey. Materials and Methods: Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms...
December 2018: Tüberküloz Ve Toraks
Mervyn Y H Koh, Jia F Lee, Socrates Montalban, Chik L Foo, Allyn Y M Hum
BACKGROUND: The American College of Emergency Physicians has identified early palliative care referral for patients with advanced cancer as a key competent of the Choosing Wisely campaign. OBJECTIVES: To study the feasibility of a new 3-way model of care between emergency department (ED), hospital palliative care department, and inpatient/home hospice. METHODS: This was a prospective, descriptive study that included oncology patients who attended the hospital ED over a 3-year period from January 2015 to December 2017...
January 23, 2019: American Journal of Hospice & Palliative Care
Tito R Mendoza, Kenneth L Kehl, Oluwatosin Bamidele, Loretta A Williams, Qiuling Shi, Charles S Cleeland, George Simon
BACKGROUND: Patients with newly diagnosed lung cancer who have not yet begun treatment may already be experiencing major symptoms produced by their disease. Understanding the symptomatic effects of cancer treatment requires knowledge of pretreatment symptoms (both severity and interference with daily activities). We assessed pretreatment symptom severity, interference, and quality of life (QOL) in treatment-naïve patients with lung cancer and report factors that correlated with symptom severity...
January 19, 2019: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Mona S Patel
Dyspnea in cancer patients can lead to significant deleterious effects. There are multiple conditions that can cause dyspnea. It is important to determine which of these causes are potentially reversible and treatable, so that they can be promptly addressed. Both pharmacologic and nonpharmacologic approaches should be used to treat this difficult condition. As patients advance in their illness, palliative treatments can be considered, such as low-dose opioids, oxygen therapy, and treatments directed at anxiety relief...
December 17, 2018: Oncology (Williston Park, NY)
David Wang, Christina Creel-Bulos
BACKGROUND: Approximately 25-30% of Americans die within hospitals. An increasingly geriatric and chronically ill population arrive at emergency departments (EDs) for their terminal presentation. Many patients will not choose, nor are EDs obligated to deliver, futile care. Instead, aggressive comfort care may alleviate patient, family, and clinician distress. OBJECTIVES: To discuss best practice through a systematic approach to comfort care transitions for the dying ED patient...
December 29, 2018: Journal of Emergency Medicine
Aziz A Ansari, Daniel H Pomerantz, Robert L Jayes, Eric A Aguirre, Rachel D Havyer
Chronic obstructive pulmonary disease (COPD) poses challenges not only in symptom management but also in prognostication. Managing COPD requires clinicians to be proficient in the primary palliative care skills of symptom management and communication focused on eliciting goals and preferences. Dyspnea should initially be managed with the combination of long-acting muscarinic antagonists and long-acting β-agonist inhalers, adding inhaled corticosteroids if symptoms persist. Opioids for the relief of dyspnea are safe when used at appropriate doses...
December 26, 2018: Journal of Palliative Care
Erin McKenzie, Liying Zhang, Pearl Zaki, Stephanie Chan, Vithusha Ganesh, Yasmeen Razvi, May Tsao, Elizabeth Barnes, Matthew K Hwang, Carlo DeAngelis, Edward Chow
BACKGROUND: Cancer patients often present with several concurrent symptoms. There is evidence to suggest that related symptoms can cluster together in stable groups. The present study sought to identify symptom clusters in advanced cancer patients using the Edmonton Symptom Assessment System (ESAS) in a palliative outpatient radiotherapy clinic. METHODS: Principal component analysis (PCA), exploratory factor analysis (EFA), and hierarchical cluster analysis (HCA) were used to identify symptom clusters among the 9 ESAS items using ESAS scores from each patient's first visit...
September 5, 2018: Annals of Palliative Medicine
Maria Aparecida Scottini, Rachel Duarte Moritz, José Eduardo de Siqueira
OBJECTIVE: Evaluating the degree of cognition, functionality, presence of symptoms and medications prescribed for patients under palliative home care. METHOD: Descriptive, cross-sectional study where 55 patients under palliative home care were interviewed. Cognition was evaluated using the Mini-Mental state examination (MM), with patients being separated into two groups: with preserved cognitive ability (MM>24), or altered (MM <24). The functionality was verified by the Palliative Performance Scale (PPS) and the patients were divided into two groups: PPS≤50 and PPS≥60...
October 2018: Revista da Associação Médica Brasileira
Alma Alihodzic-Pasalic, Veljko Maric, Ademir Hadzismailovic, Alen Pilav, Kemal Grbic
Background: Chemical pleurodesis is generally accepted palliative dyspnea therapy and preventive of re-accumulation of pleural fluid in patients with malignant pleural effusions. Aim: Comparative analyses of efficiency of chemical pleurodesis between Video Assisted Thoracoscopic Surgery (VATS) and standard thoracostomy. Methods: From 01.01.2016-01.01.2017 at the Clinic for Thoracic Surgery of University Clinical Center (UCC) Sarajevo retrospective analysis was performed...
October 2018: Acta Informatica Medica: AIM
Erin E Stevens, Janet L Abrahm
Lesbian, gay bisexual, transgender, and queer or questioning (LGBTQ) older adults have unique health care needs, especially in the palliative care and hospice setting. In this article, we present a male patient with metastatic ovarian cancer, admitted with worsening dyspnea, now at the end of life. Only his wife was aware of his identified gender, and nondisclosure was very important to him. As he continued to decline, the team navigated LGBTQ-sensitive care within the health care setting, insurance inequalities, and support and communication to his family...
December 4, 2018: Journal of Palliative Medicine
Borna E Tabibian, Arsalaan A Salehani, Elizabeth N Kuhn, Matthew C Davis, Christopher D Shank, Winfield S Fisher Iii
BACKGROUND: Involvement of the palliative care service has potential for patient and family benefit in critically ill patients, regardless of etiology. Anecdotally, there is a lack of involvement of the palliative care (PC) service in the neuro-intensive care unit (neuro-ICU), and its impact has not been rigorously investigated in this setting. OBJECTIVE: This study aims at assessing the effect of early involvement of the PC service on end-of-life care in the neuro-ICU...
November 29, 2018: Journal of Palliative Medicine
Zhu Mei, He Wang, Shengnan Ren, Juan Wei, Yanhong Gu
RATIONALE: Thymic carcinoids are a rare type of malignant neuroendocrine tumors which have a poor prognosis due to their distant metastasis, invasive behaviour, and postoperative recurrence. Surgical resection is still the fundamental mode for treating thymic carcinoids. Here, we report the rapid shrinkage of an atypical thymic carcinoid with multiple metastases following chemoradiation plus octreotide as a first-line therapy PATIENT CONCERNS:: A 39-year-old Chinese man presented with chest tightness, dyspnea with a history of lumbago and untreated malignant thymoma...
November 2018: Medicine (Baltimore)
K Rajala, J T Lehto, E Sutinen, H Kautiainen, M Myllärniemi, T Saarto
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic disease with a high symptom burden and poor survival that influences patients' health-related quality of life (HRQOL). We aimed to evaluate IPF patients' symptoms and HRQOL in a well-documented clinical cohort during their last two years of life. METHODS: In April 2015, we sent the Modified Medical Research Council Dyspnea Scale (MMRC), the modified Edmonton Symptom Assessment Scale (ESAS) and a self-rating HRQOL questionnaire (RAND-36) to 300 IPF patients, of which 247 (82%) responded...
November 20, 2018: BMC Pulmonary Medicine
Joaquim Julià-Torras, Miguel Ángel Cuervo-Pinna, Luis Cabezón-Gutiérrez, Pedro C Lara, Marisol Prats, César Margarit, Josep Porta-Sales
BACKGROUND: Episodic dyspnea is an increasingly recognized phenomenon that occurs frequently in patients with cancer. Although numerous definitions have been proposed to describe episodic dyspnea, to date, no common widely accepted definition in Spanish has yet emerged. Without a clear well-accepted definition, it is difficult to design rigorous clinical trials to evaluate candidate treatments for this emerging entity and to compare outcomes among studies. OBJECTIVE: The aim of the study was to reach a consensus definition of episodic dyspnea in the Spanish language based on professional criteria in cancer patients...
November 16, 2018: Journal of Palliative Medicine
Jiacai Cho, Jamie Zhou, Dominic Lo, Anselm Mak, Sen Hee Tay
OBJECTIVES: To determine the extent of end-of-life suffering and predictors of high symptom prevalence in the last one year of life in patients with systemic rheumatic diseases (SRDs) and the extent of supportive care received. METHODS: We identified adult patients with SRDs who died between 1 April 2006 and 1 April 2016. We collected data within 1 year before their death, on the following: (i) cumulative symptom prevalence, (ii) rates of Advance Care Planning (ACP), Do-Not-Resuscitate (DNR) orders and referral to a palliative physician...
November 2, 2018: Seminars in Arthritis and Rheumatism
Sneha Dhillon, Saurabh Bansal, Girish Sindhwani, Meenu Gupta, Vipul Nautiyal, Sunil Saini, Mushtaq Ahmad
Purpose: The aim of the study was to evaluate the short-term clinical, endoscopic response, and acute toxicities in endobronchial cancer treated with high-dose-rate endobronchial brachytherapy (HDR-EB). Materials and Methods: Thirty patients of advanced endobronchial cancers were treated with HDR-EB. Brachytherapy was delivered at a depth of 1 cm from the source axis at weeks 1, 2, and 3 with 7 Gy per fraction. All patients were evaluated before treatment and at 1 month after completion of therapy...
October 2018: South Asian Journal of Cancer
Stephanie L Stephens, J Brian Cassel, Danielle Noreika, Egidio Del Fabbro
The US population of inmates continues to increase along with a rapid escalation in the number of elderly prisoners. Previous studies have demonstrated multiple barriers to providing palliative care for seriously ill inmates. The aim of this study was to assess the frequency of palliative care consultation and nature of consultation requests for inmates who died while hospitalized at a large tertiary care hospital. A retrospective chart review of all inmate decedents over a 10-year time period was conducted...
November 14, 2018: American Journal of Hospice & Palliative Care
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