Journal of the National Comprehensive Cancer Network : JNCCN
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J Natl Compr Canc Netw · Sep 2004
ReviewPrevention, diagnosis, and treatment of invasive fungal infections in patients with cancer and neutropenia.
Invasive fungal infections are a major cause of morbidity and mortality in patients with prolonged neutropenia and in allogeneic hematopoietic stem cell transplant recipients. The degree and duration of neutropenia influence the risk of opportunistic fungal infections. ⋯ Three strategies in preventing and treating patients at high risk for fungal infection will be considered: (1) prophylaxis; (2) empirical therapy; and (3) treatment for probable or proven fungal infection. In addition to more effective antifungal agents, growing interest has been noted in novel non-culture detection methods to facilitate early diagnosis of invasive fungal infections.
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J Natl Compr Canc Netw · Sep 2004
ReviewAdvanced ovarian cancer: a clinical update on first-line treatment, recurrent disease, and new agents.
Platinum-based therapy plays an integral role in the first-line treatment of advanced ovarian cancer as well as in the recurrent disease setting. In advanced disease, the standard of care in the United States is maximal surgical cytoreduction followed by paclitaxel/carboplatin chemotherapy. Results from the Gynecologic Oncology Group COG 158 trial show that paclitaxel/carboplatin is at least as effective as paclitaxel/cisplatin and is better tolerated and easier to administer. ⋯ Recent results from the International Collaborative Ovarian Neoplasm ICON 4 trial indicate that paclitaxel/carboplatin may offer superior efficacy to single-agent carboplatin. Additional randomized comparisons of carboplatin versus other carboplatin combinations are in progress. Finally, a variety of new cytotoxic and biologic agents are being evaluated in recurrent disease, either as single agents or in combination with standard chemotherapy.
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Opioid-induced bowel dysfunction is a major complication in oncology practice and must be approached aggressively. Every patient starting opioids should be thoroughly instructed in the management of this side effect. Prevention is the key and use of agents such as senna and a stool softener with the initiation of therapy is mandatory, with rapid titration if the initial dose is not effective. ⋯ Other agents then can be added as necessary. Fecal impaction must always be considered and it should be recognized that it may lead to other symptoms such as increased pain, urinary difficulties, or nausea and vomiting. In summary, the words of Dame Cicely Saunders, founder of the hospice movement, must be kept in mind: "Remember the bowels".
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J Natl Compr Canc Netw · Jul 2003
Assessment of pain caused by invasive procedures in cancer patients.
Invasive procedures are commonly required in the diagnosis and management of cancer in adults. However, little is known regarding the prevalence and severity of procedure-related pain in this patient population. This prospective study was conducted to determine the frequency and types of invasive procedures performed in a large comprehensive cancer center, the intensity of pain associated with these procedures, the types of periprocedural analgesics administered, and how these patients would like their procedural pain to be managed in the future. ⋯ There was no statistical relationship between patients' pain ratings and their satisfaction with the pain control they received during the procedures. This study represents the largest descriptive study of procedural pain in adult cancer patients. As more than 50% of these patients experienced moderate to severe pain during procedures, further studies are needed to improve the control of procedure-related pain in patients with cancer.