Anaesthesia
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Acute pain in cancer is an important but often overlooked feature of many patients' oncological journey. Cancer-related pain is associated commonly with more persistent pain states caused by both the disease and its treatment, but there are numerous causes of acute pain which can develop in patients with cancer. This pain is frequently severe, can be challenging to manage and its suboptimal control can directly impact on oncological outcomes. This narrative review provides an overview of several causes of acute pain in patients with cancer and management approaches. ⋯ As the oncological treatment landscape shifts and increasing numbers of novel treatments are employed, the number of causes of acute pain in patients with cancer rises. This pain is often managed by non-pain specialists and suboptimal control has a variety of deleterious effects. It is important that awareness of acute pain in the oncological population is increased and treatment approaches, which adopt a biopsychosocial structure, are optimised.
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Cancer complicates approximately 1 in 2000 pregnancies, with increasing incidence due to factors such as increased maternal age, obesity and advancements in antenatal testing. Anaesthetists play a crucial role in managing pregnant patients with cancer, both during delivery and in providing anaesthesia for oncological treatments. This review explores the challenges in anaesthetic management and specific considerations for common cancers encountered in pregnant patients. ⋯ Effective and safe anaesthetic management of cancer in pregnancy requires a multidisciplinary approach to balance maternal and fetal safety, with a focus on careful planning and individualised care.
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Review
The increasing global burden of cancer: implications for anaesthesia and peri-operative medicine.
Most patients with cancer will require surgery at some point in their lifetime. As the global burden of cancer continues to increase, changes and challenges in cancer epidemiology and care are also borne peri-operatively. ⋯ Deeper engagement of anaesthetists in cancer care programmes will be instrumental in reducing postoperative complications; improving the quality of life for patients; enhancing population health; and contributing to improved global economies.
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Patients with advanced ovarian cancer often require radical cytoreductive surgery and chemotherapy, with or without targeted therapy. Return to intended oncological therapy after surgery is a crucial metric, as delay can worsen survival. The concept of return to intended oncological therapy is important because it highlights the need for not just successful surgical outcomes, but also the ability to continue with the comprehensive cancer treatment plan. ⋯ Awareness and management of factors affecting return to intended oncological therapy are essential for improving outcomes in patients with advanced ovarian cancer. We highlight the importance of multidisciplinary care (including enhanced recovery after surgery programmes) and the factors affecting these including age; nutrition; and occurrence of postoperative complications.
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The peri-operative period may create a biological environment conducive to cancer cell survival and dissemination. Microscopic residual tumours (micrometastases) can be dislodged even with excellent surgical technique. At the same time, the stress response from surgery can temporarily impair immune function and activate inflammatory processes, increasing the risk of tumour proliferation. ⋯ There is a complex interplay between anaesthetic and analgesic techniques and cancer outcomes. Despite promising data from laboratory experimental models, the balance of available clinical trials indicates an equivalent influence of all evaluated anaesthetic techniques on long-term oncologic outcomes, except, possibly, for peritumoral or intraperitoneal local anaesthetic infiltration.