RESUMEN
AIMS: Patients with locally advanced pancreatic cancer (LAPC) are most commonly managed with chemotherapy or concurrent chemoradiotherapy (CRT), which may or may not include non-involved regional lymph nodes in the clinical target volume. We present our results of CRT for LAPC using capecitabine and delivering radiotherapy to a limited radiation field that excluded non-involved regional lymph nodes from the clinical target volume. MATERIALS AND METHODS: Thirty patients were studied. Patients received 50.4 Gy external beam radiotherapy in 28 fractions, delivered to a planning target volume expanded from the primary tumour and involved nodes only. Capecitabine (500-600 mg/m2) was given twice daily continuously during radiotherapy. Toxicity and efficacy data were prospectively collected. RESULTS: Nausea, vomiting and tumour pain were the most common grade 2 toxicities. One patient developed grade 3 nausea. The median time to progression was 8.8 months, with 20% remaining progression free at 1 year. The median overall survival was 9.7 months with a 1 year survival of 30%. Of 21 patients with imaged progression, 13 (62%) progressed systemically, three (14%) had local progression, two (10%) had locoregional progression and three (14%) progressed with both local/locoregional and systemic disease. CONCLUSION: CRT using capecitabine and limited field radiotherapy is a well-tolerated, relatively efficacious treatment for LAPC. The low toxicity and low regional progression rates support the use of limited field radiotherapy, allowing evaluation of this regimen with other anti-cancer agents.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/radioterapia , Antimetabolitos Antineoplásicos/uso terapéutico , Desoxicitidina/análogos & derivados , Fluorouracilo/análogos & derivados , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/radioterapia , Profármacos/uso terapéutico , Adenocarcinoma/patología , Anciano , Anciano de 80 o más Años , Capecitabina , Terapia Combinada , Desoxicitidina/uso terapéutico , Progresión de la Enfermedad , Femenino , Fluorouracilo/uso terapéutico , Humanos , Masculino , Dosis Máxima Tolerada , Persona de Mediana Edad , Neoplasias Pancreáticas/patología , Estudios Prospectivos , Dosificación Radioterapéutica , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
ALTHOUGH STILL CONTROVERSIAL, studies suggest that music therapy can be an effective nursing intervention in stressful situations for decreasing anxiety, blood pressure, and heart rate. This article (1) reviews research related to the effect of music on anxiety, blood pressure, and heart rate; (2) proposes a potential physiological framework for the effects of music; and (3) suggests clinical implications for the use of music therapy in acute- and chronic-care settings by clinical nurse specialists (CNSs). Findings from clinical research suggesting that music may facilitate a reduction in the stress response include decreased anxiety levels, decreased blood pressure and heart rate, and changes in plasma stress hormone levels. Findings from laboratory research using animal models, provide beginning, although speculative, support for a physiological framework of music's influence on the stress response. Music therapy may be useful in a wide range of clinical settings with patients experiencing health problems as diverse as hypertension/cardiovascular disease, migraine headaches, and gastrointestinal ulcers. Suggestions for development of a music therapy procedure and for areas in need of additional research are offered.
Asunto(s)
Musicoterapia/normas , Estrés Psicológico/terapia , Animales , Encéfalo/fisiología , Modelos Animales de Enfermedad , Humanos , Enfermeras Clínicas , Estrés Psicológico/fisiopatología , Estrés Psicológico/psicologíaRESUMEN
The purpose of this study was to describe patient comprehension of discharge instruction materials used by one gastroenterology department. Two conceptual frameworks, Orem's self-care model of nursing and Klare's reading comprehension model, were used to guide research design and to explain study findings. A descriptive correlational design was used to explore the relationship between years of schooling, word recognition, and reading comprehension. The study participants (n = 30) included 10 male and 20 female patients. Mean years of schooling was post-high school; mean word recognition score was high school level. Findings included moderate correlation between years of schooling and word recognition scores (r = .64) and strong correlation between word recognition and reading comprehension scores (r = .77-.82). Reading comprehension scores for the majority of participants (60%) were at the frustration comprehension level. Findings suggest that word recognition ability and educational level may be insufficient to ensure comprehension.