Hematology/oncology clinics of North America
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Depression is a common complication of advanced cancer. Methods of accurate assessment and recognition are available. Risk factors for the development of depression have been identified. Pharmacologic and nonpharmacologic treatments for depression are often effective even in patients with advanced cancer.
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Although most patients with cancer pain can attain a favorable balance between analgesia and side effects with a conventional approach to opioid therapy, a substantial minority cannot. For these patients, an important subgroup of whom have neuropathic pain, alternative therapeutic strategies are needed. With a detailed assessment, clinicians should be able to choose among the large and diverse group of options available and implement an approach, or combination of approaches, that have a high probability of improving analgesic outcomes.
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When considered with other parameters, prognostic factors of survival in far advanced cancer patients are necessary to enable the doctor, the patient, and his or her relative to choose the most suitable clinical management and care setting. Original studies and literature reviews, albeit with methodologic difficulties, have identified the most important prognostic factors as being: CPS, KPS, signs and symptoms relating to nutritional status (i.e., weight loss, anorexia, dysphagia, xerostomia), other symptoms (dyspnea, cognitive failure) and some simple biologic parameters (serum albumin level, number of white blood cells and lymphocyte ratio). Some authors have weighed the different impact of the most important prognostic factors and have integrated them into prognostic scores for clinical use. Despite the usefulness of these instruments, however, the communication of a poor prognosis is one of the most difficult moments to face in the relationship between doctor and patient.
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Evaluation and treatment of fatigue in cancer patients requires a multidisciplinary approach because it has many possible etiologies and several contributing factors. A comprehensive approach is required, especially for patients with moderate to severe fatigue, so that all possible contributing factors can be determined and an appropriate treatment plan can be created. ⋯ The short- and long-term effects of an exercise program on the fatigue levels and overall physical performance of cancer patients should be assessed in new studies. Clearly, much more research is needed not only to identify factors responsible for the fatigue but also to develop effective interventions for cancer-related fatigue.
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Hematol. Oncol. Clin. North Am. · Aug 2001
ReviewPediatric hematology-oncology outreach for developing countries.
Health care in some developing countries is now at a level that makes programs for care of children with cancer feasible. Examples of successful international programs in this field include twinning programs, nongovernmental assistance organizations, such as the National Children's Cancer Society, and committees of professional organizations, such as the International Society of Pediatric Oncology (SIOP). ⋯ Jude Children's Research Hospital includes training programs within the hospital, partner sites in 13 countries, a school for Latin American nurses, a distance learning website, and telecommunications programs, which are described in detail. Future programs should be designed to maximize and evaluate impact, report accomplishments and failures, and avoid duplication.