Supportive Care Research Papers - Academia.edu (original) (raw)

The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. Materials and methods Multinational... more

The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. Materials and methods Multinational Association of Supportive Care in Cancer members were invited to participate in a survey on oral CT. Nurse coordinators collected data via a 16-item questionnaire. Respondents totaled 1115 oncology nurses from 15 countries. Results Findings showed that about half of subjects work in outpatient/ambulatory clinics and had given at least two or more oral CT drugs. Although 52% had some type of guidelines/protocols, 47% reported not having received any

Purpose To establish physiotherapy management of cancer-related fatigue (CRF), in particular, to determine physiotherapy exercise management of CRF. Methods All physiotherapist members of the UK Association of Chartered Physiotherapists... more

Purpose To establish physiotherapy management of cancer-related fatigue (CRF), in particular, to determine physiotherapy exercise management of CRF. Methods All physiotherapist members of the UK Association of Chartered Physiotherapists in Oncology and Palliative Care (ACPOPC) received a questionnaire. Results The response rate was 65% (223/341). Therapists had a mean of 6.8 years (+/−5.6) experience in oncology and/or palliative care. Seventy-eight percent of therapists recommend and/or use exercise as part of the management of CRF; 74% teach other strategies, most commonly energy-conservation techniques (79%). Therapists recommend and/or use exercise in similar frequencies with a range of cancer types, before (32%), during (53%) and following treatment (59%) and during advanced stages of the disease (68%). The most common barrier encountered by therapists in recommending and/or using exercise was related to the lack-of-exercise guidelines for patients with CRF (71%).

# Springer-Verlag 2006 able quality of life and risk factor outcomes.

Goals of work: Partners of cancer patients may experience significant distress at the time of treatment and many may experience persistent difficulties, although little research has examined their longer term psychosocial outcomes or... more

Goals of work: Partners of cancer patients may experience significant distress at the time of treatment and many may experience persistent difficulties, although little research has examined their longer term psychosocial outcomes or supportive care needs. Materials and methods: One hundred and fifty-four cancer survivors who were 1-11 years post diagnosis and disease-free and their partners completed mailed questionnaires. Main results: A positive relationship was found between psychological distress and supportive care needs both within and between partner and survivor samples. Partners reported high levels of anxiety and supportive care needs, most frequently concerning relationships and the impact of the cancer illness. Partners within couples reported both shared and unique needs, although agreement on ratings of shared needs was low. Needs did not diminish over time although partners demonstrated psychological resilience and reported positive outcomes. Predictors of distress and unmet needs were explored: physical QOL, relationship satisfaction, and total needs contributed to variability in partners' distress; relationship satisfaction and total needs were associated with survivors' distress. Distress and relationship satisfaction were associated with partners' unmet needs; only distress was associated with survivors' unmet needs. Conclusions: Partners are not merely providers of support, but need support themselves many years after a cancer diagnosis and in the context of apparently cured disease. The quality of the dyadic relationship may be critical in determining both partner and survivor distress and needs, and may prove a useful target for psychosocial interventions.

The results of a questionnaire answered by 205 medical patients are reported (100 patients with cancer and 105 with other medical conditions). The questionnaire examined beliefs and preferences regarding various aspects of cancer,... more

The results of a questionnaire answered by 205 medical patients are reported (100 patients with cancer and 105 with other medical conditions). The questionnaire examined beliefs and preferences regarding various aspects of cancer, including expectations of medical management and treatment. The issues examined relate to beliefs and preferences about information giving, trust of doctors' control of decision making, expectations of help, expectations of treatment, the treatment of cancer pain including morphine use, and issues of terminal care. Some patients appear to hold the inconsistent beliefs that doctors should tell them all they want to know, but that doctors do not know a lot of what they would like to be told. They were also ambivalent about who should make decisions, patient or doctor, suggesting a preference for collaborative consensus decision making. It may be important to inform patients more clearly about what doctors can and cannot reasonably be expected to know and do. Some incorrect beliefs about management were related to fear about having cancer. The results suggest the need for better communication between patients and their professional carers and the need for accessible health information about cancer management to be available to the general public.

Purpose To examine the prevalence of exercise in head and neck cancer survivors and determine preliminary associations with quality of life (QoL), fatigue, and depression. Materials and methods Fifty-nine of 65 (91%) eligible head and... more

Purpose To examine the prevalence of exercise in head and neck cancer survivors and determine preliminary associations with quality of life (QoL), fatigue, and depression. Materials and methods Fifty-nine of 65 (91%) eligible head and neck cancer survivors recruited from an academic oncology clinic completed a self-administered survey including the modified Godin Leisure-Time Exercise Questionnaire and Functional Assessment of Cancer Therapy-Head & Neck (FACT-H&N), which includes physical, social, emotional and functional well-being (FWB) as well as additional concerns, and the FACT-General (FACT-G). Medical variables were obtained by medical record review. Results The majority of participants were men (83%) and were Caucasian (92%), with mean age of 58±12.8. Cancer sites were primarily the oral cavity (24%), oropharynx (37%), or larynx (25%), with 20% being stage I, 7% stage II, 19% stage III, and 54% stage IV disease. Chemotherapy and/or radiation were ongoing in 14% of the participants. Half of the participants (51%) were diagnosed <6 months ago. Only three (5%) participants reported any vigorous exercise minutes (M=7.3±35.4), and only seven (12%) participants reported any moderate exercise minutes (M=19.5±70.6). Light exercise was reported by 26 (44%) (M=83.4±147.1). Only five (8.5%) participants were meeting current public health exercise guidelines. Partial correlations adjusting for age, medical comorbidity, and alcohol use showed that the total exercise minutes (i.e., light + moderate + vigorous) was positively associated with FWB (r=0.30, p=0.027), FACT-G (r=0.25, p=0.071), and FACT-H&N (r=0.26, p=0.064), was negatively associated with fatigue (r=−0.27, p=0.051), and had no association with depression (r=0.10, p=0.500). Conclusions Few head and neck cancer survivors are participating in any moderate or vigorous exercise, and over half are completely sedentary. Meaningful and potentially beneficial associations between total exercise minutes, QoL, and fatigue were demonstrated. An exercise intervention may have utility in this understudied cancer survivor group. Further research is warranted.

Goals of work: Discussing end-of-life issues is of key importance to terminally ill cancer patients and their families, and a challenging topic for both health professionals and patients/carers. There is a lack of research evidence in the... more

Goals of work: Discussing end-of-life issues is of key importance to terminally ill cancer patients and their families, and a challenging topic for both health professionals and patients/carers. There is a lack of research evidence in the literature to guide clinical practice. The objective of this study was to explore the optimal content and phrasing of information when discussing the dying process and end-of-life issues with terminally ill cancer patients and their carers. Subjects and methods: We conducted focus groups and individual interviews with 19 palliative care patients and 24 carers from three palliative care services in Sydney, and 22 palliative care health professionals from around Australia. The focus groups and individual interviews were audiotaped and fully transcribed. Further focus groups and/ or individual interviews were conducted until no additional topics were raised. Participants' narratives were analysed using qualitative methodology. Main results: Distinct content areas emerged for discussing end-oflife issues: treatment decisions at the end-of-life; potential future symptoms; preferences for place of death; the process of dying; what needs to be done immediately after death; and existential issues. When discussing the process of dying participants recommended: exploring the persons' fears about dying and dispelling myths; describing the final days and the likely unconscious period; and the reduced need for food and fluids. Many participants identified the dilemma regarding whether to discuss potential complications around the time of death. Conclusions: This paper provides strategies, words and phrases which may inform discussions about the process of dying and end-of-life issues. Further research is needed to determine the generalizability of these findings.

Aims The use of subcutaneous infusion ports has become standard practice to provide a long-term venous access in oncological patients. The aim of this retrospective study was to assess the different complications of infusion ports in our... more

Aims The use of subcutaneous infusion ports has become standard practice to provide a long-term venous access in oncological patients. The aim of this retrospective study was to assess the different complications of infusion ports in our population and to identify predisposing factors. Patients and methods We reviewed the medical records of 437 patients who were followed at the Oncology/Haematology Department of our hospital. Of these patients, there were 370 (84.4%) with solid tumours and 58 (13.2%) with haematological disease. The position of the catheter tip was evaluated by reviewing the available chest radiographs or phlebographies. Main results Analysis of the records showed that 346 patients (79.17%) had no complications. The most common complications after implantation were thrombosis (8.46%), catheter dysfunction (4.8%) and infections (4.4%). Univariate and multivariate analysis showed that catheter tip positioning was the most important predisposing risk factor for thrombosis. Catheter tips positioned in the brachiocephalic vein or in the cranial part of the superior vena cava were associated with a high risk of thrombosis. Other significant risk factors were gender and initial diagnosis. Female patients and patients with lung cancer also had an elevated risk of developing a thrombosis. Conclusions Compared to other reports, we noted a higher rate of thrombosis and port dysfunction. Since catheter tip position was a predisposing factor for developing a thrombosis, correct catheter position has to be ensured during placement. Prophylactic antithrombotic treatment might be beneficial in the event of failure to position the catheter correctly.

Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic... more

Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic and assessment tools are limited, and quality of care, particularly regarding conservative and palliative care, is suboptimal. The KDIGO Controversies Conference on Supportive Care in CKD reviewed the current state of knowledge in order to define a roadmap to guide clinical and research activities focused on improving the outcomes of people living with advanced CKD, including those on dialysis. An international group of multidisciplinary experts in CKD, palliative care, methodology, economics, and education identified the key issues related to palliative care in this population. The conference led to a working plan to address outstanding issues in this arena, and this executive summary serves as an output to guide future work, including the development of globally applicable guidelines. Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Annual mortality of patients on dialysis exceeds 20%. Withdrawal from dialysis is a common cause of death for dialysis patients worldwide, reflecting their poor health-related quality of life (HRQL), although this may be owing to nonmedical reasons in low-income and lower-middle-income countries. The high level of disability and symptom burden in some patients with advanced CKD is not necessarily improved by dialysis. To improve the quality of care, it is now recognized that palliative care principles need to be integrated into the routine care of these patients. Despite great need, palliative care is under-utilized among patients with advanced CKD compared with other chronic disease populations, even in countries where such care is available. 1,2 Rates of hospitalization, intensive care unit admissions, and other intensive treatments are higher for CKD patients in the last month of life compared with other severe chronic illnesses, including chronic obstructive lung disease, congestive heart failure, and advanced liver disease. 3 Current evidence suggests that end-of-life care practices are not consistent with preferences of patients with advanced CKD (i.e., GFR categories G4 and G5). 4 The majority of dialysis patients die in acute care facilities, receiving high-intensity care that may be unwanted. 1 Health systems and policies that integrate palliative care are urgently required to optimize the care of CKD patients. To achieve international, multidisciplinary, transparent, and unbiased analysis, Kidney http://www.kidney-international.org m e e t i n g r e p o r t

Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic... more

Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic and assessment tools are limited, and quality of care, particularly regarding conservative and palliative care, is suboptimal. The KDIGO Controversies Conference on Supportive Care in CKD reviewed the current state of knowledge in order to define a roadmap to guide clinical and research activities focused on improving the outcomes of people living with advanced CKD, including those on dialysis. An international group of multidisciplinary experts in CKD, palliative care, methodology, economics, and education identified the key issues related to palliative care in this population. The conference led to a working plan to address outstanding issues in this arena, and this executive summary serves as an output to guide future work, including the development of globally applicable guidelines.

Nausea and vomiting are known side effects for cancer therapy. The prevalence is around 40-80%. The level of emetoginicity varies based on different factors. The potential receptors involved in emesis pathway are dopamine receptors,... more

Nausea and vomiting are known side effects for cancer therapy. The prevalence is around 40-80%. The level of emetoginicity varies based on different factors. The potential receptors involved in emesis pathway are dopamine receptors, 5-hydroxytryptamine type 3 receptors and neurokinin receptors. The main guidelines for prevention of nausea and vomiting are ASCO, NCCN, MASCC/ESMO. These guidelines recommend three antiemetic drugs for highly emetic chemotherapy and two antiemetic drugs for moderately emetic chemotherapy. While for low risk regimens single antiemetic might be used and for minimal risk regimens antiemetic is not routinely recommended. Non pharmacological therapy might be considered as well. There are different tools for assessment of nausea and vomiting such as EORTC-QLQ-C30 and FACT-G. The Multinational Association of Supportive Care in Cancer (MASCC) tool individually address both acute and delayed nausea and vomiting, available in different languages and has iPhone/iPad application. Proper prevention of this side effect is highly recommended to improve patient quality of life, to avoid further complications as dehydration, electrolyte imbalance and to ensure continuation of treatment plan.

Objective: Health care professionals and policy makers acknowledge that spiritual needs are important for many patients with life-limiting illnesses. We asked such patients to describe their spiritual needs and how these needs may impinge... more

Objective: Health care professionals and policy makers acknowledge that spiritual needs are important for many patients with life-limiting illnesses. We asked such patients to describe their spiritual needs and how these needs may impinge on their physical, psychological, and social well-being. Patients were also encouraged to explain in what ways their spiritual needs, if they had any, could be addressed.

Purpose Migrants with cancer struggle to communicate with their health care team. This study aimed to identify health-care related unmet needs and communication issues for migrants who develop cancer and factors associated with these... more

Purpose Migrants with cancer struggle to communicate with their health care team. This study aimed to identify health-care related unmet needs and communication issues for migrants who develop cancer and factors associated with these challenges. In this paper, the findings related to communication issues are presented. Patients and methods Seventy-three cancer patients diagnosed within the previous 3 years and 18 carers, who had migrated to Australia and spoke the designated languages, participated in focus groups or structured interviews. Participants were recruited from ethnic community support organisations, support groups and Oncology clinics within three metropolitan hospitals in two states of Australia. Focus groups and semi-structured interviews were conducted in participants' own language or English as preferred, audio-taped, transcribed and translated into English and analysed using qualitative methods. Results Four themes emerged: (1) cultural isolation, alienation and identification; (2) language and communication difficulties; (3) interpreter issues; and (4) advice for health professionals. Participants, especially those less acculturated, described feeling alone and misunderstood, failing to comprehend medical instructions, being unable to communicate questions and concerns and a lack of consistency in interpreters and interpretation.

Background: Several studies report that practicing Yoga may lead to numerous psycho-physiological benefits in patients undergoing treatment for cancer. Moreover, it may result in an effective alternative for coping with sleep... more

Background: Several studies report that practicing Yoga may lead to numerous psycho-physiological benefits in patients undergoing treatment for cancer. Moreover, it may result in an effective alternative for coping with sleep disturbances, anxiety, depression and fatigue symptoms. A study based on the "Yoga in Oncology" project of the Foundation Poliambulanza was carried out, and it was designed to explore the benefits of Yoga, therefore corroborating Yoga as a therapeutic activity that can have a beneficial impact on patients diagnosed with cancer. Methods: Seventy patients were recruited, of whom 20% were males and 80% were females 18 years of age and older. All patients were being treated at the oncology department for gastrointestinal, mammary or genital carcinoma, and the disease was metastatic in 80% of patients. Data were collected between April 2013 and May 2017. The protocol consisted of a weekly 90-minute Yoga lesson for 8 consecutive weeks, and the data collection was carried out in 2 phases: (T0) preprotocol assessment and (T1) postprotocol assessment. Psychophysiological assessment was carried out with the following scales: the (BFI) Brief Fatigue Inventory, (HADS) Hospital Anxiety and Depression Scale and (PSQI) Pittsburgh Sleep Quality Index. Results: Data analysis showed a significant difference between the (T0) and (T1) HADS (Hospital Anxiety and Depression Scale) scores. The constructs of this scale consist of psychological variables for the assessment of anxiety and depression. In contrast, scores from the (BFI) Brief Fatigue Inventory and (PSQI) Pittsburgh Sleep Quality Index did not show significant differences between (T0) and (T1): such scales are relative to psychophysiological variables for an assessment of the perception of fatigue and quality of sleep. Conclusion: It is noteworthy that the data, once analyzed, showed a significant difference between preprotocol and postprotocol levels of anxiety and depression but not for the perception of fatigue or the quality of sleep. In accordance with the scientific literature, data from this study highlight that practicing Yoga may promote changes in the levels of perceived anxiety and depression in patients undergoing treatment for cancer, thus positively affecting their (QoL). It is clear that the difference in significance between the psychological and physiological variables considered here and the statistical significance found only in levels of anxiety and depression encourage further studies to account for the nature of fatigue and sleep disturbances and how to address these symptoms in oncological patients. Moreover, other points of interest for future clinical research regard the evaluation of the reason for the possible denial to participate to this kind of study, as well as the social-cultural differences in patients' behavior.

Background: During the different phases of cancer treatment, it may be evident distress among patients and their families, and high scores, as measured by the Distress Thermometer (DT), indicate the need for intervention aimed at... more

Background: During the different phases of cancer treatment, it may be evident distress among patients and their families, and high scores, as measured by the Distress Thermometer (DT), indicate the need for intervention aimed at reduction or elimination of psychological and psychiatric disorders. The current study aimed to assess the incidence of distress and discuss the quality of care provided in a private cancer center, located in the Federal District. Methods: 169 patients of both genders (37.9% men e 62.1% women) and aged between 17 and 86 years (M = 53), responded to DT in three distinct phases of the chemotherapy protocol: beginning, middle and end. Results: In the first stage of evaluation, most patients had significant level of distress (69.8%). During the treatment, there was progressive reduction in the second (32.4%) and last stage of evaluation (14.3%). Conclusion: The significant reduction of distress over the treatment can be understood as an indicator of quality of service. During the study, there was a practice more humane, because the interventions were being adjusted to the needs of each case. Finally, it is suggested to carry out more research into the use of DT as a measure of indirect assessment of quality of care in Oncology.

The objective of this study was to assess the psychometric properties of the Thai version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) version 3.0. The questionnaire was... more

The objective of this study was to assess the psychometric properties of the Thai version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) version 3.0. The questionnaire was completed by 310 cancer patients during their follow-up at 2 teaching hospital oncology clinics. About 70% of participants had advanced stage of cancer and 72% had been receiving chemotherapy. Cronbach's a coefficients of the six scales were above 0.7, except for cognitive and social function scales. All test-retest reliability coefficients were high. Multitrait scaling analysis showed that all item-scale correlation coefficients met the standards of convergent and discriminant validity. Most scales and items could discriminate between subgroups of patients with different clinical status assessed with the Eastern Cooperative Oncology Group (ECOG) scale. The results suggested that the EORTC QLQ-C30 and the Functional Assessment of Cancer Therapy -General (FACT-G) measured different aspects of quality of life and should be independently used. Testing psychometric properties of the EORTC QLQ-C30 in heterogeneous diagnostic group yield similar results as found in homogeneous group. These results support that the EORTC QLQ-C30 (version 3.0) has proven to be a reliable and valid measure of the quality of life in Thai patients with various types of cancer.

Assess the prevalence of distress and quality of life of cancer patients over the course of chemotherapy. Method. Longitudinal prospective study addressing 200 patients. The Distress Thermometer (DT) and Functional Assessment of... more

Assess the prevalence of distress and quality of life
of cancer patients over the course of chemotherapy. Method.
Longitudinal prospective study addressing 200 patients. The
Distress Thermometer (DT) and Functional Assessment of
Chronic Illness Therapy-General (FACT-G), as indicators of
distress and quality of life, were applied at three points in time
during chemotherapy: the first day (T1), half way through the
treatment (T2), and last day of medication (T3). Results. The
average age was 56.8 years old, and 70% were women while
the most frequent types of cancer included breast (30%) and
hematological (22%) cancers. The number of patients with a high
level of distress statistically decreased over time (T1=41.5%,
T2=8.0% and T3=2.5%); consequently, quality of life scores
improved (T1=85.6%, T2=90.4% and T3=92.0%). Patients
with moderate to severe distress experienced worse quality of life.
Distress, type of cancer and disease stage significantly impacted
quality of life. Conclusion. There was a reduction in the time
of impact from the side effects of chemotherapy in the patients
as a consequence of adapting to the diagnosis and treatment.
Continuous assessment of the needs of patients is essential to
ensuring integral and humanized care, contributing to improved
oncological nursing.

As global cancer incidence is increasing with well documented poorer outcomes, cancer is receiving increasing attention in Latin America and the Caribbean. Due to the urgency of the cancer burden in developing countries (LMIC) where... more

As global cancer incidence is increasing with well documented poorer outcomes, cancer is receiving increasing attention in Latin America and the Caribbean. Due to the urgency of the cancer burden in developing countries (LMIC) where mortality ranges from 50‐90% compared to the 20‐40% range for developed countries (except for lung cancer), we are compelled to ask provocative questions and cultivate innovative best approaches in research and practice for more rapid translation of new knowledge and implementation of interventions to bring whole person cancer care and reduce the undue burden of cancer in this region. Further, mounting evidence directs our attention to the social determinants of cancer outcomes. Yet, there are several challenges in examining broad social contexts requiring the inclusion and guidance of survivor‐advocates. This symposium will discuss survivorship outcomes and survivorship care development within the Caribbean region focusing on two specific nations Brazil and Trinidad and Tobago. Our findings indicate high cancer related societal and survivor burden. The health care systems in LMIC countries are overwhelmed with the increasing cancer incidence. Multilevel factors including socioeconomic status, quality of care, distress screening and management seem to be associated with patient outcomes. Developing psychosocial and supportive care in developing countries involve the engagement of multisectorial stakeholders including civil society, government, healthcare system, clinicians, advocates and patients. The need to develop these cancer care components is urgent and compelling.

Distress should be assessed as part of routine cancer care. Considering the lack of resource in developing countries and the international evidence, a biopsychosocial screening routine was implemented in distinct health care systems in... more

Distress should be assessed as part of routine cancer care. Considering the lack of resource in developing countries and the international evidence, a biopsychosocial screening routine was implemented in distinct health care systems in Brazil, supported by a NCI R25‐E training program. We sought to provide an overview of the development and implementation of these programs and report initial results to extend international research. The training program guided on effective biopsychosocial screening implementation strategies, which was translated and applied at a public (low levels of education/income) and at two private settings in Brazil. A study was implemented to establish the prevalence of patient distress. A total of 1262 patients who were undergoing chemotherapy were recruited. The majority was female, diagnosed with GI and breast cancers at an advanced disease stage. The prevalence of moderate to severe distress was higher among patients from public hospital (41.2% vs 26.9% and 19.1%). Patients tended to report more emotional and physical symptoms with a small difference on the prevalence between cancer settings. However, differences emerged in the types of problems reported, which may have implications for the structure of supportive care in these settings. These findings provided evidence that a biopsychosocial screening program is feasible in a developing country. This screening assisted thousands of patients with psychosocial concerns, focusing on their needs. This training directly impacted the quality of clinical care provided at each institution.

To provide an updated overview about the role of spirituality and religiosity in the way patients with lifethreatening illnesses cope, and the importance of providing a comprehensive spiritual assessment and spiritual care in an... more

To provide an updated overview about the role of spirituality and religiosity in the way patients with lifethreatening illnesses cope, and the importance of providing a comprehensive spiritual assessment and spiritual care in an interdisciplinary team work setting, such as supportive and palliative care.

The clinical pharmacist in oncology care team has a crucial role in patient care through improving use of chemotherapy and other high alert medications. As part of multidisciplinary team, clinical pharmacist needs to assure safe,... more

The clinical pharmacist in oncology care team has a crucial role in patient care through improving use of chemotherapy and other high alert medications. As part of multidisciplinary team, clinical pharmacist needs to assure safe, effective, cost-effective and more patient-oriented drug therapy. Adverse Drug Reactions are noxious and unintended death causing factor in cancer treatment. Antineoplastic drugs were mostly prescribed for cancer patients, who has greater suspectability towards ADRs. Along with other onco healthcare professionals, clinical pharmacist intervention in the treatment planning of the cancer patients, can identify, detect, assess, educate, monitor, minimize, prevent & manage the ANAs induced ADRs by supportive antidote therapy & palliative care, that can produce a impact by minimize economic burden & improving QOL, which can be sudden & significant, the latter can be particularly important to patients who want to live as normally as possible after diagnosis. The p value of the current study was found to be 0.006 (highly significant). & Chi-square value was 18.04, which shows a directly proportional association b/w ADR probability scores & stages of cancer.

The book presents the materials of the third All-Ukrainian scientific-practical seminar "Horizons of post-traumatic personal life-creating". Emphasis is placed on the most pressing issues of personal transformation during the COVID-19... more

The book presents the materials of the third All-Ukrainian scientific-practical seminar "Horizons of post-traumatic personal life-creating". Emphasis is placed on the most pressing issues of personal transformation during the COVID-19 pandemic: the peculiarities of everyday life, actualized fears, personal resources, and supportive interaction. Tolerance and intolerance of the person to uncertainty are investigated, problems of adaptation of teenagers, first-year students, internally displaced persons, adults who have lost parents are covered. Means of mastering stressful and post-traumatic states of personality are offered: coping strategies, body-oriented and respiratory technologies, various forms of psychological support, and psychological help, including online help and museum therapy. The problems of destiny, social intelligence, dialogue, personal experiences, self-depreciation, aggressive behavior in special conditions of life are outlined.

Goals of work The purpose of this study is to compare the treatment and retention effects between standard decongestive lymphatic therapy (DLT) combined with pneumatic compression (PC) and modified DLT, in which the use of a short-stretch... more

Goals of work The purpose of this study is to compare the treatment and retention effects between standard decongestive lymphatic therapy (DLT) combined with pneumatic compression (PC) and modified DLT, in which the use of a short-stretch bandage is replaced with the use of Kinesio tape (K-tape) combined with PC. Materials and methods Forty-one patients with unilateral breast-cancer-related lymphedema for at least 3 months were randomly grouped into the DLT group (bandage group, N= 21) or the modified DLT group (K-tape group, N=20). Skin care, 30-min manual lymphatic drainage, 1-h pneumatic compression therapy, application of a short-stretch bandage or K-tape for each group, and a 20-min physical therapy exercise were given during every treatment session. Patient evaluation items included physical therapy assessment, limb size, water composition of the upper extremity, lymphedema-related symptoms, quality of life, and patients' acceptance to the bandage or tape.

Neurotoxic anticancer drugs, such as platinum-based anticancer drugs, taxanes, vinca alkaloids, and proteasome/angiogenesis inhibitors are responsible for chemotherapy-induced peripheral neuropathy (CIPN). The health consequences of CIPN... more

Neurotoxic anticancer drugs, such as platinum-based anticancer drugs, taxanes, vinca alkaloids, and proteasome/angiogenesis inhibitors are responsible for chemotherapy-induced peripheral neuropathy (CIPN). The health consequences of CIPN remain worrying as it is associated with several comorbidities and affects a specific population of patients already impacted by cancer, a strong driver for declines in older adults. The purpose of this review is to present a comprehensive overview of the long-term effects of CIPN in cancer patients and survivors. Pathophysiological mechanisms and risk factors are also presented. Neurotoxic mechanisms leading to CIPNs are not yet fully understood but involve neuronopathy and/or axonopathy, mainly associated with DNA damage, oxidative stress, mitochondria toxicity, and ion channel remodeling in the neurons of the peripheral nervous system. Classical symptoms of CIPNs are peripheral neuropathy with a " stocking and glove " distribution characterized by sensory loss, paresthesia, dysesthesia and numbness, sometimes associated with neuropathic pain in the most serious cases. Several risk factors can promote CIPN as a function of the anticancer drug considered, such as cumulative dose, treatment duration, history of neuropathy, combination of therapies and genetic polymorphisms. CIPNs are frequent in cancer patients with an overall incidence of approximately 38% (possibly up to 90% of patients treated with oxaliplatin). Finally, the long-term reversibility of these CIPNs remain questionable, notably in the case of platinum-based anticancer drugs and taxanes, for which CIPN may last several years after the end of anticancer chemotherapies. These long-term effects are associated with comorbidities such as depression, insomnia, falls Frontiers in Pharmacology | www.frontiersin.org 1 February 2017 | Volume 8 | Article 86 Kerckhove et al. Long-Term Effects of CIPNs and decreases of health-related quality of life in cancer patients and survivors. However, it is noteworthy that these long-term effects remain poorly studied, and only limited data are available such as in the case of bortezomib and thalidomide-induced peripheral neuropathy.

Aims: The use of subcutaneous infusion ports has become standard practice to provide a longterm venous access in oncological patients. The aim of this retrospective study was to assess the different complications of infusion ports in our... more

Aims: The use of subcutaneous infusion ports has become standard practice to provide a longterm venous access in oncological patients. The aim of this retrospective study was to assess the different complications of infusion ports in our population and to identify predisposing factors. Patients and methods: We reviewed the medical records of 437 patients who were followed at the Oncology/Haematology Department of our hospital. Of these patients, there were 370 (84.4%) with solid tumours and 58 (13.

Goal of the work Anemia is a common side effect of chemotherapy. Limited information exists about its inci-dence and risk factors. The objective of this study was to evaluate the incidence of anemia and risk factors for anemia occurrence... more

Goal of the work Anemia is a common side effect of chemotherapy. Limited information exists about its inci-dence and risk factors. The objective of this study was to evaluate the incidence of anemia and risk factors for anemia occurrence in patients with early breast cancer who received adjuvant chemotherapy. 0.52 (P=0.0045) for WBC. Age, surgery type, platelets, body mass index, and length of time from surgery to chemotherapy were not significant predictors. Cox regression results looking at time to anemia were similar. Conclusions Moderate or severe anemia is rare among patients treated with AC followed by CMF. Low baseline hemoglobin and WBC are associated with a higher risk of anemia.

Goal of work Little is known about complementary therapy services (CTs) available in Canadian palliative care settings. Materials and methods An online survey was e-mailed to multiple Canadian palliative care settings to determine the... more

Goal of work Little is known about complementary therapy services (CTs) available in Canadian palliative care settings. Materials and methods An online survey was e-mailed to multiple Canadian palliative care settings to determine the types and frequency of CTs provided and allowed, who are the CT providers, funding of CT services, and barriers to the provision of CTs. Main results The response rate was 54% (74/136). Eleven percent of surveyed palliative care settings provided CTs, and 45% allowed CTs to be brought in or to be used by patients. The three most commonly used CTs were music (57%), massage therapy (57%), and therapeutic touch (48%). Less than 25% of patients received CTs in the settings that provided and/or allowed these therapies. CTs were mostly provided by volunteers, and at most settings, limited or no funding was available. Barriers to the delivery of CTs included lack of funding (67%), insufficient knowledge of CTs by staff (49%), and limited knowledge on how to successfully operate a CT service (44%). For settings that did not provide or allow CTs, 44% felt it was important or very important for their patients to have access to CTs. The most common reasons not to provide or allow CTs were insufficient staff knowledge of CTs (67%) and lack of CT personnel (44%). Conclusions Overall, these findings were similar to those reported in a US-based hospice survey after which this survey was patterned. Possible reasons for these shared findings and important directions regarding the future of CT service provision in Canadian palliative care setting are discussed.

Abstract Breast cancer is the most common cancer among women worldwide. Women with breast cancer report numerous supportive care needs throughout the illness trajectory, including informational, psychological, physical, and daily living... more

Abstract Breast cancer is the most common cancer among
women worldwide. Women with breast cancer report numerous supportive care needs throughout the illness trajectory, including informational, psychological, physical, and daily living challenges. Whilst information about the prevalence
and predictors of supportive care needs is essential to guide
service planning, little is known about how such needs differ
around the world. An integrative review of research published
since 2012 was undertaken to examine the supportive care/
unmet needs of women with breast cancer from Asian or Caucasian origins. Of the 23 articles identified, results suggest that Asian women report higher levels of health system and information needs, whereas Caucasian women report higher psychological needs. Unmet needs may be predicted by age, marital status, symptom distress, depression or anxiety, and care satisfaction, regardless of Asian/Caucasian status. Future
cross-cultural research employing longitudinal designs and/
or examining intervention efficacy to address unmet needs is
warranted.

Goals of work Ginger has been used to treat numerous types of nausea and vomiting. Ginger has also been studied for its efficacy for acute chemotherapy-induced nausea and vomiting (CINV). However, its efficacy for delayed CINV in a... more

Goals of work Ginger has been used to treat numerous types of nausea and vomiting. Ginger has also been studied for its efficacy for acute chemotherapy-induced nausea and vomiting (CINV). However, its efficacy for delayed CINV in a diverse oncology population is unknown. Materials and methods We performed a randomized, double-blind, placebo-controlled trial in 162 patients with cancer who were receiving chemotherapy and had experienced CINV during at least one previous round of chemotherapy. All participants were receiving a 5-HT 3 receptor antagonists and/or aprepitant. Participants were randomized to receive either 1.0 g ginger, 2.0 g ginger daily, or matching placebo for 3 days. The primary outcome was change in the prevalence of delayed CINV. Secondary outcomes included acute prevalence of CINV, acute and delayed severity of CINV, and assessment of blinding.

Purpose To validate the Brazilian version of the Brief Pain Inventory (BPI-B) scale and to determine the optimal cutpoints for mild, moderate, and severe pain based on patients' rating of their worst pain. Methods One hundred forty-three... more

Purpose To validate the Brazilian version of the Brief Pain Inventory (BPI-B) scale and to determine the optimal cutpoints for mild, moderate, and severe pain based on patients' rating of their worst pain. Methods One hundred forty-three outpatients with cancer were recruited in Hospital das Clinicas-University of Sao Paulo, Brazil. Results Confirmatory factor analysis confirmed two underlying dimensions, pain severity, and pain interference, with Cronbach's α of 0.91 and 0.87, respectively. Convergent validity was shown by the correlation observed between the BPI dimensions with the EORTC-QLQ-C30 pain scale and the McGill Pain Questionnaire. The BPI-B detected significant differences in the two dimensions by disease and performance status, supporting known-group validity. For the worst pain, the optimal cutpoints were 4 and 7 (1-4= mild pain, 5-7=moderate, and 8-10=severe). Conclusions Our data show that BPI-B is a brief, useful, and valid tool for assessing pain and its impact on patient's life.

In the palliative care setting, the Edmonton Symptom Assessment Scale (ESAS) was developed for use in daily symptom assessment of palliative care patients. ESAS considers the presence and severity of nine symptoms common in cancer... more

In the palliative care setting, the Edmonton Symptom Assessment Scale (ESAS) was developed for use in daily symptom assessment of palliative care patients. ESAS considers the presence and severity of nine symptoms common in cancer patients: pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath plus an optional tenth symptom, which can be added by the patient. The aim of this study was to validate the Italian version of ESAS and to evaluate an easy quality of life monitoring system that uses a patient’s self-rating symptom assessment in two different palliative care settings: in-patients and home patients. Eighty-three in-patients and 158 home care patients were enrolled. In the latter group, the Italian validated version of the Symptom Distress Scale (SDS) was also administered at the admission of the patients. The two groups of patients have similar median survival, demographic and clinical characteristics, symptom prevalence and overall distress score at baseline. ESAS shows a good concurrent validity with respect to SDS. The correlation between the physical items of ESAS and SDS was shown to be higher than the correlation between the psychological items. The association of ESAS scores and performance status (PS) showed a trend: the higher the symptom score was, the worse was the PS level. Test–retest evaluation, applied in the in-patient group, showed good agreement for depression, well-being and overall distress and a moderate agreement for all the other items. In conclusion, ESAS can be considered a valid, reliable and feasible instrument for physical symptom assessment in routine “palliative care” clinical practice with a potentially different responsiveness in different situations or care settings.

Objective The objective of this paper is to inform choice of optimal patient-reported outcome measures (PROMs) of anxiety, depression and general distress for studies evaluating psychosocial interventions for Englishspeaking adults with... more

Objective The objective of this paper is to inform choice of optimal patient-reported outcome measures (PROMs) of anxiety, depression and general distress for studies evaluating psychosocial interventions for Englishspeaking adults with heterogenous cancer diagnoses.

Purpose The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. Materials and methods... more

Purpose The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. Materials and methods Multinational Association of Supportive Care in Cancer members were invited to participate in a survey on oral CT. Nurse coordinators collected data via a 16-item questionnaire. Respondents totaled 1115 oncology nurses from 15 countries.

As pessimism saps energy in the twilight of our lives lived in the twilight of a civilization, what is the antidote? The session will probe the power of positivity encoded in words. Following an introduction to the keyword "Resilience"... more

As pessimism saps energy in the twilight of our lives lived in the twilight of a civilization, what is the antidote? The session will probe the power of positivity encoded in words. Following an introduction to the keyword "Resilience" discussion will follows, with participants contributing keywords that engender vibrancy in ourselves and in society. The instructor/ calligrapher will then inscribe all the participants' keywords on the blackboard onto a large 2.5 foot by 8 foot recycled sliding shutter.

Background Cancer patients usually take many medications. The proportion of patients with advanced cancer who are taking futile drugs is unknown. Materials and methods We retrospectively reviewed the charts of all consecutive ambulatory... more

Background Cancer patients usually take many medications. The proportion of patients with advanced cancer who are taking futile drugs is unknown. Materials and methods We retrospectively reviewed the charts of all consecutive ambulatory patients with advanced cancer and who were receiving supportive care exclusively at palliative care clinics, Princess Margaret Hospital, to gather information on futile medications used by them. Futile medications were defined as unnecessary (when no short-term benefit to patients with respect to survival, quality of life, or symptom control was anticipated) or duplicate (two or more drugs from the same pharmacological class). Summary statistics were used to describe the results. Results From November 2005 to July 2006, 82 (22%) of 372 patients were taking at least one futile medication before consultation; after initial consultation, this proportion dropped to 20% (78): 70 patients were taking unnecessary medications, while eight were on duplicate medications. The most frequent unnecessary medications used by patients were statins (56%). The most common duplicate medication involved the use of two different benzodiazepines (seven patients). Conclusion About one fifth of cancer outpatients at the end of life take futile medications, most commonly statins. Prospective and population-based studies are warranted to further evaluate the magnitude and consequences of futile medication use in oncology.

Objectives We used intravenous midazolam and ketamine for children undergoing minor operative procedures with satisfactory results. We aimed to further evaluate its efficacy and adverse effects in pediatric ward setting. Methods This was... more

Objectives We used intravenous midazolam and ketamine for children undergoing minor operative procedures with satisfactory results. We aimed to further evaluate its efficacy and adverse effects in pediatric ward setting. Methods This was a prospective study of all children undergoing minor operations with sedation in our pediatric general and oncology wards from July 1998 to June 1999. The procedures included lumber puncture±intrathecal chemotherapy, bone marrow aspiration±trephine biopsy, central venous catheter removal, skin biopsy, or their combination. All sedation procedures were started with midazolam 0.1 mg/kg and ketamine 1 mg/kg; they were increased gradually to 0.4 and 4 mg/kg, respectively, if necessary. Heart rate and SaO2 were continuously monitored. Results Altogether, 369 minor operations were performed in 112 patients (male:female=2:1, median age 6 years, range 5 months–17 years). All achieved adequate sedation, with 96% within 30 s and 75% required just the starting dose. Younger children required a higher dosage (p=0.003 for midazolam, pp=0.001). Adverse effects included tachycardia (27.9%), increased secretion (17.6%), agitation (13.6%), nausea and vomiting (9.2%), hallucination (8.7%), desaturation (8.4%), and cataleptic reaction (0.8%). All desaturation episodes were transient and responded to oxygen supplement alone. None developed bronchospasm or convulsion. Some adverse effects were dose-related. Half of the children who received 0.3 mg/kg midazolam developed desaturation. Conclusions Intravenous midazolam–ketamine can provide rapid, effective, and safe sedation for children undergoing minor operations in ward setting. Adverse effects are mild. Midazolam above 0.3 mg/kg should be used with caution.

For many years, dementia care has been dominated by the standard medical approach, in which dementia is treated mainly with drugs, such as anti-anxiety, antidepressant and anti-psychotic medications. With the aim of seeking effective... more

For many years, dementia care has been dominated by the standard medical approach, in which dementia is treated mainly with drugs, such as anti-anxiety, antidepressant and anti-psychotic medications. With the aim of seeking effective treatments for patients with dementia, over the last years, several contributions have criticised the pervasive use of drugs for the management of behavioural and physiological symptoms related to dementia, proposing personalised interventions aimed at supporting patients and their relatives from diagnosis until death. With particular reference to long-term settings, in this work, we aim at understanding the organisational implications of three types of interventions (labelled supportive care interventions-SCIs) that have characterised this shift in dementia care: person-centred, palliative and multidisciplinary care. Conducted by following the integrative review method, our review underlines how SCIs have controversial consequences on the quality of care, the care-givers' quality of life and cultural backgrounds. After an in-depth analysis of selected papers, we offer some considerations about the implications of SCIs for long-term care organisations and future research directions.

While significance of the concept of meaning in understanding adaptation to cancer is widely accepted, it has been little studied, especially in longitudinal data. This study aims to clarify the role of global meaning and meaning-related... more

While significance of the concept of meaning in understanding adaptation to cancer is widely accepted, it has been little studied, especially in longitudinal data. This study aims to clarify the role of global meaning and meaning-related life attitudes (death acceptance and goal seeking) in predicting different aspects of psychological and existential distress by reference to a specified research model.

Goals Malnutrition in the head and neck cancer population is a widely recognized factor contributing to negative outcomes. The goal of this study was to determine if providing complimentary oral nutritional supplementation for patients... more

Goals Malnutrition in the head and neck cancer population is a widely recognized factor contributing to negative outcomes. The goal of this study was to determine if providing complimentary oral nutritional supplementation for patients undergoing definitive radiation therapy for oropharyngeal carcinoma reduced weight loss and the need for percutaneous endoscopic gastrostomy (PEG) tube placement. Materials and methods The data from 79 patients undergoing radiotherapy for oropharyngeal cancer were extracted and analyzed retrospectively from an institutional Human Investigation Committee approved database for the study of advanced radiation therapy techniques for head and neck cancer. Forty patients were treated before the initiation of a nutritional supplementation program, and 39 patients received supplementation. Patients were stratified by type of treatment (radiation alone or chemoradiation) and whether or not they had a PEG tube. Results All patient groups receiving supplementation manifested a significant decrease in weight loss compared to those who did not receive it. Nutritional supplementation was associated with a 40% relative reduction in weight loss in patients treated with radiotherapy alone (6.1 vs 10.1%, p=0.008) and a 37% reduction in weight loss in patients treated with chemoradiotherapy (6.7 vs 10.7%, p=0.007). When patients were stratified by the presence or absence of a PEG tube, both groups experienced a 39% relative reduction in weight loss (with PEG, 5.7 vs 9.3%, p= 0.028; without PEG, 6.9 vs 11.2%, p=0.002). Supplementation was associated with a decreased need for PEG tube placement (31% decreased to 6%) in patients treated with radiotherapy alone. Conclusions Providing complimentary oral nutritional supplementation significantly decreases weight loss and the need for PEG tube placement in patients undergoing radiation therapy for oropharyngeal cancer.