RESUMEN
GOALS OF WORK: The objective of this study was to determine the effect of infliximab, an antitumor necrosis factor alpha (TNFalpha) antibody, on fatigue in patients with advanced cancer. MATERIALS AND METHODS: This was a pilot study undertaken in a specialist palliative care unit. Seventeen eligible outpatients were enrolled in this study. Infliximab 5 mg/kg was administered intravenously at baseline and if there was observable clinical benefit, every 4 weeks thereafter until clinical benefit was lost. The primary outcome measure assessing subjective functional improvement was the change in fatigue severity scale (FSS) score at 4 weeks following an infliximab infusion. Secondary outcome measures of subjective functional improvement that were assessed 4 weeks after each infliximab infusion included changes in Karnofsky performance status (KPS), hospital anxiety and depression scale (HADS) score, anxiety and depression subscores, and appetite visual analogue scale. Clinical laboratory assessments were C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), TNFalpha, interleukin-6, and leptin concentrations. MAIN RESULTS: At week 4, 9 of 14 patients improved in FSS, 3 of 15 improved in KPS, 7 of 15 improved in total HADS and the majority had modest improvements in serum CRP, ESR, or leptin concentrations. Case studies of six patients with overall improvement are described in detail. Five serious adverse events occurred; two were serious infections possibly related to treatment. CONCLUSIONS: A subgroup of patients in this small pilot study demonstrated uniform subjective/clinical benefit. We were not able to identify any predictors of this response; a larger, controlled study may reveal more information.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Fatiga/tratamiento farmacológico , Fatiga/fisiopatología , Neoplasias/fisiopatología , Adulto , Anciano , Anticuerpos Monoclonales/administración & dosificación , Femenino , Hospitales para Enfermos Terminales , Humanos , Infliximab , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Proyectos Piloto , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Enabling individuals to achieve their maximum potential and quality of life following a diagnosis of advanced cancer, has long been a stated aim of palliative care. Increased life expectancy and the introduction of specialist palliative care to patients at an earlier stage of their illness presents professionals in the specialty with new challenges in meeting the need for rehabilitative care. This article examines some of the recent developments affecting the provision of rehabilitative care and describes one specialist palliative care unit's response to the challenge, highlighting the role of a nurse-led clinic within the service framework.
Asunto(s)
Centros de Día/organización & administración , Cuidados Paliativos al Final de la Vida/organización & administración , Neoplasias/enfermería , Neoplasias/rehabilitación , Enfermería Oncológica/organización & administración , Cuidados Paliativos/organización & administración , Enfermería en Rehabilitación/organización & administración , Instituciones de Atención Ambulatoria/organización & administración , Enfermedad Crónica , Humanos , Esperanza de Vida , Londres , Evaluación de Necesidades , Neoplasias/mortalidad , Grupo de Atención al Paciente/organización & administración , Evaluación de Programas y Proyectos de Salud , Derivación y Consulta , Especialización , Análisis de SupervivenciaRESUMEN
Uncontrolled studies have reported that fatigue is a common symptom among patients with advanced cancer. It is also a frequent complaint among the general population. Simply asking cancer patients whether or not they feel fatigued does not distinguish between the 'background' level of this symptom in the community and any 'excess' arising as a result of illness. The aim of this study was to determine the prevalence of fatigue among palliative care inpatients in comparison with a control group of age and sex-matched volunteers without cancer. In addition, the correlates of fatigue were investigated. The prevalence of 'severe subjective fatigue' (defined as fatigue greater than that experienced by 95% of the control group) was found to be 75%. Patients were malnourished, had diminished muscle function and were suffering from a number of physical and mental symptoms. The severity of fatigue was unrelated to age, sex, diagnosis, presence or site of metastases, anaemia, dose of opioid or steroid, any of the haematological or biochemical indices (except urea), nutritional status, voluntary muscle function, or mood. A multivariate analysis found that fatigue severity was significantly associated with pain and dypnoea scores in the patients, and with the symptoms of anxiety and depression in the controls. The authors conclude that subjective fatigue is both prevalent and severe among patients with advanced cancer. The causes of this symptom remain obscure. Further work is required in order to determine if the associations reported between fatigue and pain and between fatigue and dyspnoea are causal or coincidental.
Asunto(s)
Fatiga/epidemiología , Neoplasias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Estudios Transversales , Fatiga/etiología , Femenino , Fuerza de la Mano/fisiología , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias/complicaciones , Neoplasias/patología , Cuidados Paliativos , Prevalencia , Estudios Prospectivos , Calidad de Vida , Análisis de Regresión , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
Terminal restlessness is a clinical phenomenon that is frequently observed but poorly defined. Its management is important in providing good quality palliative care. We present the development of an objective observer-rated instrument to measure terminal restlessness.
Asunto(s)
Neoplasias , Agitación Psicomotora/diagnóstico , Cuidado Terminal , Humanos , Neoplasias/psicología , Examen Neurológico , Variaciones Dependientes del Observador , Sensibilidad y EspecificidadRESUMEN
Radiation therapy of the length of the spinal column presents various clinical and physical problems. The completed plan may be complicated to set up, be time-consuming and require daily variation to achieve reasonable dose homogeneity. A case of medulloblastoma is used to illustrate the steps in producing a plan for dynamic treatment using a computer-controlled tracking cobalt unit. After definition by computed tomography, the target is considered in segments in order to develop a plan which keeps the spinal cord constantly positioned at the beam isocentre. The main computer is used to develop the patient treatment file and information is transferred to a second computer which controls and monitors the safe functioning of the cobalt unit. The cranial fields are treated separately in a conventional way. Good and consistent control of the dose distribution is achieved along the entire target volume. This technique is a marked improvement over all existing methods of treating the spinal axis.
Asunto(s)
Neoplasias Cerebelosas/radioterapia , Radioisótopos de Cobalto/uso terapéutico , Computadores , Meduloblastoma/radioterapia , Neoplasias Cerebelosas/diagnóstico por imagen , Preescolar , Humanos , Masculino , Meduloblastoma/diagnóstico por imagen , Radioterapia/instrumentación , Tomografía Computarizada por Rayos XRESUMEN
Forty-one patients with inflammatory or degenerative arthritis and a history of gastric disturbance on other non-steroid anti-inflammatory drugs, or of peptic ulceration were treated with fenbufen 600-1200 mg dialy, and followed up for 3-17 months in an open study. Twelve patients withdrew because of lack of effect of the drug on the arthritic symptoms. Four patients withdrew because of non-gastrointestinal side effects. Three patients withdrew because of continuing dyspepsia. Twenty-two patients continued on fenbufen without dyspepsia or evidence of gastro-intestinal bleeding for 3-17 months (mean 8.3 months). These results suggest that fenbufen can be tolerated by patients with a history of gastro-intestinal disturbance on other NSAIDs, and that a larger controlled study would be warranted.