Aromatisation of dehydroepiandrosterone by hormone dependent human mammary cancer MCF-7 subcellular fractions

Abstract

egies to keep patients comfortable [l] and to respond to the patients’ and families’ queries and needs [2]. Unfortunately, prognostic information obtained by clinical observation tends to overestimate length of survival [3-51, even when predictions are made close to the patient’s death [4], and regardless of who makes the prediction [3, 4]-general practitioners, hospice physicians, general hospital physicians, nurses or social workers. Research indicates that the frequency and severity of pain and dyspnoea increase as cancer p&ients approach death [6-81. In the last days of life, dyspnoea is the major uncontrollable, severe symptom [9]. For dyspnoea and other problems, patients can be best cared for and made most comfortable when clinicians are alerted to their prognostic importance. We studied prospectively 120 consecutive patients (73 men and 47 women) with terminal cancer. They were followed up daily until death, by a palliative home care team. In 63 patients (52.5%) 80 episodes of symptoms that patients called unendurable and that physicians termed difficult to control occurred. These symptoms included: dyspnoea (33 patients), pain (31), delirium (11) and vomiting (5). In Table 1 we indicate the frequency of these symptoms in relation to time of death. They occurred in 96.8% of patients within a week of death, and in over half within the last 24 hours (mean 49.2 h, S.D. 65.7, range 2-400). 6. McKegney FP, Bailey L, Yates J. Prediction and management of pain in patients with advanced cancer. Gen Hosp Psychiat 1981, 3, 95-101. 7. Morris JN, Mor V, Goldberg RJ, Sherwood S, Greer DS, Hiris J. The effect of treatment setting and patient characteristics on pain in terminal cancer patients: a report from the National Hospice Study. 3 Chron Dis 1986,39,27-35. 8. Reuben DB, Mor V. Dyspnea in terminally ill cancer patients. Chest 1986,2,234-236. 9. Higginson I, McCarthy M. Measuring symptoms in terminal cancer: are pain and dyspnoea controlled?3 R Sot Med 1989,82,264267.