Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Dec 2013
ReviewNutritional counseling and nutritional supplements: a cornerstone of multidisciplinary cancer care for cachectic patients.
The challenge with cancer cachexia is that it is not fully reversed by nutrition support. The purpose of this review is to provide an opinion on the nutritional management of cancer cachexia based on the most recent available evidence. ⋯ Further research into the most appropriate methods for identifying and treating cancer cachexia is required. Regardless of whether patients are experiencing reduced dietary intake resulting in malnutrition or due to cachexia, nutrition remains a cornerstone of multimodal treatment.
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Patients with brain tumours show a high symptom burden, and symptoms are difficult to treat and prone to be overlooked. This review of publications dealing with advanced stages of brain tumours tries to assess the knowledge gained in the past 2 years and to develop an outlook for further investigations. ⋯ Data suggest that patients with primary or metastatic brain tumours often have a high symptom burden and unmet needs for palliative care, and symptoms are hard to diagnose; patients suffer often and early from cognitive impairment but are rarely appropriately prepared concerning end-of-life wishes. This reflects on their caregivers' burden as well. For symptomatic treatment of common symptoms such as fatigue, depression and cognitive impairment, methylphenidate has established an important role. For assessment of these symptoms, a shortened questionnaire Quality of Life Questionnaire-15-Palliative shows potential. Cancer-directed therapy in advanced stages of brain tumours has to be weighed critically. To assess adequate strategies to help patients and caregivers with the challenges of brain tumour-specific symptoms, randomized intervention studies are necessary. The same accounts for cancer-directed treatment in relation to quality of life in advanced stages of brain tumours.
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Curr Opin Support Palliat Care · Dec 2013
ReviewA systematic review of the influence of opioids on advanced cancer patient survival.
Many health professionals still believe that opioids shorten the lifespan of patients. This situation implies that the ethical doctrine of double effect is often invoked to justify their use in extreme circumstances. The objective of this study is to revise the evidence existing in the recently published literature regarding the effect on patient survival of opioid used to control disease symptoms. ⋯ The studies revised have not shown that the use of opioids for symptom control in advanced disease stages or in the last days of life has any effect on patient survival. Similarly, survival was not influenced by either the use of higher or lower doses of opioids, or by the practice of administering a double dose at night.
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Curr Opin Support Palliat Care · Jun 2013
ReviewModels of delivering palliative and end-of-life care in India.
India is home to one-fifth of the global population. This review aims to explore the structures, functions and relevance of palliative care services in India. Although palliative care has been initiated in India almost 3 decades ago, development of services has been patchy and inadequate. Some of the regions are well covered, but most are not. The Indian palliative care scene, with its diversity in approach and delivery of services, can offer valuable lessons to service development in low-income and middle-income countries. ⋯ The state of palliative care in India is discussed with particular attention to the successful Kerala Model in palliative care. Lessons learned from the experiment in Kerala are listed.