Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2013
ReviewChallenges in research related to perioperative cancer care and cancer outcomes.
Surgery is one of the most commonly used treatments to attempt cure of early-stage and some late-stage solid tumours. Paradoxically, surgery itself and some of the medical interventions involved in the perioperative care of cancer patients may be associated with an increased chance of metastasis. Researchers and perioperative clinicians have studied the phenomenon of surgery-induced immunosuppression and postoperative cancer recurrence for several decades. ⋯ Moreover, a recent proliferation of retrospective studies with conflicting results and significant limitations has not shed light on the understanding of whether regional anaesthesia, anti-inflammatory interventions or blockade of the sympathetic response improve survival after cancer surgery. Ultimately, randomised controlled trials are required to answer some of the questions raised by preclinical and retrospective studies; however, investigators face many challenges in conducting these trials. Unless sufficient funding is obtained and cooperative research is developed in the near future, clinicians will not know whether anticancer perioperative interventions are useful to improve cancer-related survivals.
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Best Pract Res Clin Anaesthesiol · Dec 2013
ReviewIntensive care for the cancer patient - unique clinical and ethical challenges and outcome prediction in the critically ill cancer patient.
With the rising number of cancer cases and increasing survival times, cancer patients with critical illness are increasingly presenting to the intensive care unit. This article considers the unique challenges they pose in terms of oncological-specific disease processes and treatment and reviews current trends in outcome prediction. We also consider the ethical standpoints surrounding the treatment of patients for whom there may be no cure and their subsequent transition to palliative care, should it become necessary.
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Best Pract Res Clin Anaesthesiol · Dec 2013
ReviewUnderstanding clinical strategies that may impact tumour growth and metastatic spread at the time of cancer surgery.
The role of the perioperative period during cancer surgery and its impact on patients' long-term cancer outcomes are of increasing interest. Anticipation and prevention of perioperative immunosuppression and targeted therapeutic interventions that translate to reduced cancer recurrence are increasingly being explored. ⋯ Anaesthesiologists caring for patients with cancer may preferentially employ regional anaesthesia techniques and anti-inflammatory agents to minimise perioperative immunosuppression and preserve perioperative homeostasis. However, prospective trials powered for long-term cancer outcomes are necessary to provide an evidence base before these strategies are to be recommended for routine clinical practice.
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The perioperative evaluation of patients with cancer differs from that of other patients in that the former may have received prior chemotherapy or radiation therapy. These cancer treatments have a wide range of side effects and complications that may affect patients' perioperative risks. ⋯ The perioperative specialist must also be familiar with the natural history of cancer and have a basic understanding of how cancer affects the body. In this article, we review the perioperative concerns that are specific to the patient with cancer.
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The global burden of cancer is increasing. By 2020, the global cancer burden is expected to rise by 50% owing to the increasingly elderly population. ⋯ Coordinated, team-based cancer care will be essential to ensure value-based care. Short and long-term outcome measurement is an integral part of the process.