Symptom Management In Cancer Patients Research Articles

Symptom Management for Cancer Patients: A Trial Comparing Two Multimodal Interventions

The results of a randomized controlled trial that tested the effects of eight-week, six-contact multidimensional interactive interventions for symptom management are presented. Four hundred and thirty-five cancer patients with solid tumors undergoing chemotherapy were randomized to receive either nurse-assisted symptom management (NASM) or automated telephone symptom management (ATSM). A prior trial established the effectiveness of NASM compared with conventional care. Seventeen symptoms commonly experienced by patients undergoing chemotherapy were rated on a scale from 0 to 10 and were evaluated at baseline, at each of the six intervention contacts, and postintervention observation at 10 weeks. Both groups achieved significant reduction in symptom severity over baseline, and there was no difference between groups on symptom severity at 10 weeks. Randomization accounted for possible reductions in severity due to response shifts. Severity of symptoms reported by patients at each of the six intervention contacts was measured using a Rasch model. Symptom pattern was different for lung and non-lung cancer patients, and they were analyzed separately. Longitudinal analyses revealed that lung cancer patients with greater symptom severity withdrew from later intervention contacts of the ATSM. The results suggest that both NASM and ATSM achieved a clinically significant reduction in symptom severity. The NASM may be more effective than ATSM in retaining lung cancer patients in the intervention. Further testing of ATSM supplemented by NASM for patients with severe symptoms is warranted.

Neoplastic pulmonary lymphangitis: Symptomatic treatment and quality-of-life evaluation in a prospective palliative care series

19536 Background: Neoplastic lymphangitis, or lymphangitis carcinomatosa, is a rare and distressing form of lung metastasis, for which symptom improvement is strongly necessary. Since measuring quality of life is an important step toward improving symptom management in cancer patients, and dyspnea in pulmonary lymphangitis is a complex syndrome in end-of-life care, we focused on evaluating a cohort of those individuals. Methods: 52 consecutive patients with neoplastic pulmonary lymphangitis (NPL) were prospectivelly followed in 3 services, with quality of life (QoL) evaluation also, using Medical Outcomes Study 36-item Short-Form Health Survey (SF- 36) and Saint George's Respiratory Questionnaire (SGRQ). Results: 65% (34) of patients were female; age ranged from 37 to 84 years (median: 60). Primary tumor sites were: 28 lung (54%), 18 breast (35%), 5 digestive (9%) and 1 bone cancer. Histological findings were of adenocarcinoma in most cases (71%). Karnofsky performance scale ranged from 10 to 90% (median: 60%); 52% (27) patients had other comorbidities (Charlson index ranged from 6–10; median 7); 48% (25) were previous smokers; hemoglobin levels ranged from 4.9 to 16.7 g/dL (median: 12). We also evaluated 33 patients with echocardiography, and 13 (43%) of them had signs of associated pulmonary hypertension; ejection fraction ranged from 46 to 83% (median: 69%); diastolic dysfunction was present in 22 and pericardial effusion in 10 patients. At accrual, median QoL scores were of: 32% (range: 0–84%) for SF-36 (scale with 0 worst) and 66% (range: 0–100%) for SGRQ (scale with 100% worst). Treatment is showed in a table below. Median survival was of 4 months (range: 0.2–40+ months); 22 (42%) of the patients had an unusual longer survival of more than 6 months, still showing good QoL scores. Conclusions: Despite the fact that QoL is generally poor and survival is short for patients with NPL, some patients may have longer survival time and some improvement is possible with active palliative care. [Table: see text] No significant financial relationships to disclose.

A Physician's Guide to Pain and Symptom Management in Cancer Patients, 2nd edition: Palliative Medicine: A Case-Based Manual, 2nd edition A Physician's Guide to Pain and Symptom Management in Cancer Patients, 2nd edition . By Janet Abrahm , M.D. Baltimore and London: The Johns Hopkins University Press, 2005, 489 pages (paperback), $24.95. Palliative Medicine: A Case-Based Manual, 2nd edition .

Journal of Palliative MedicineVol. 9, No. 6 Book and Media ReviewsA Physician's Guide to Pain and Symptom Management in Cancer Patients, 2nd edition: Palliative Medicine: A Case-Based Manual, 2nd editionCharles F. von Gunten and Gary HsinCharles F. von GuntenSearch for more papers by this author and Gary HsinSearch for more papers by this authorPublished Online:22 Dec 2006https://doi.org/10.1089/jpm.2006.9.1492AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "A Physician's Guide to Pain and Symptom Management in Cancer Patients, 2nd edition: Palliative Medicine: A Case-Based Manual, 2nd edition." , 9(6), pp. 1492–1493FiguresReferencesRelatedDetails Volume 9Issue 6Dec 2006 InformationCopyright 2006, Mary Ann Liebert, Inc.To cite this article:Charles F. von Gunten and Gary Hsin.A Physician's Guide to Pain and Symptom Management in Cancer Patients, 2nd edition: Palliative Medicine: A Case-Based Manual, 2nd edition.Journal of Palliative Medicine.Dec 2006.1492-1493.http://doi.org/10.1089/jpm.2006.9.1492Published in Volume: 9 Issue 6: December 22, 2006PDF download

A Physician's Guide to Pain and Symptom Management in Cancer Patients

A Physician's Guide to Pain and Symptom Management in Cancer Patients

Book Review: A Physician's Guide to Pain and Symptom Management in Cancer Patients, 2nd Edition

Book Review: A Physician's Guide to Pain and Symptom Management in Cancer Patients, 2nd Edition

A Physician’s Guide to Pain and Symptom Management in Cancer Patients.

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Elevated Serum Cytokines Correlated with Altered Behavior, Serum Cortisol Rhythm, and Dampened 24-Hour Rest-Activity Patterns in Patients with Metastatic Colorectal Cancer

Incapacitating symptom burden in cancer patients contributes to poor quality of life (QOL) and can influence treatment outcomes because of poor tolerance to therapy. In this study, the role of circulating cytokines in the production symptoms in cancer patients is evaluated. Eighty patients with metastatic colorectal cancer with either normal (group I, n = 40) or dampened (group II, n = 40) 24-hour rest/activity patterns measured by actigraphy were identified. Actigraphy patterns were correlated with QOL indices, serum cortisol obtained at 8:00 a.m. and 4:00 p.m. and with serum levels of transforming growth factor-alpha, tumor necrosis factor-alpha, and interleukin 6 (IL-6) obtained at 8:00 a.m. and analyzed in duplicate by ELISA. Cytokine levels and survival were also correlated. Group II patients had significantly higher pre treatment levels of all three cytokines, displayed significantly poorer emotional and social functioning, had higher fatigue, more appetite loss, and poorer performance status compared with group I patients. Transforming growth factor-alpha (TGF-alpha) and IL-6 were significantly increased in the patients with WHO performance status >1 and in those with appetite loss. Fatigue was significantly associated with elevated TGF-alpha only. IL-6 was increased in those patients with extensive liver involvement and multiple organ replacement, and it was significantly correlated with dampened cortisol rhythm. In a multivariate analysis, IL-6 was correlated with poor treatment outcome. Significant correlations were found between serum levels of TGF-alpha and IL-6, circadian patterns in wrist activity and serum cortisol and tumor-related symptoms in patients with metastatic colorectal cancer. These data support the hypothesis that some cancer patient's symptoms of fatigue, poor QOL, and treatment outcome are related to tumor or host generated cytokines and could reflect cytokine effects on the circadian timing system. This interplay between cytokine signaling pathways, the hypothalamic-pituitary-adrenal axis, the autonomic nervous system, and efferent pathways of the suprachiasmatic nucleus that control circadian physiology, opens the way to new rational interventions for symptom management in cancer patients.

Reframing hope: meaning-centered care for patients near the end of life. Interview by Karen S. Heller.

979 Dr. William Breitbart, chief of the Psychiatry Service at Memorial Sloan-Kettering Cancer Center in New York City, describes his current research on a meaning-centered psychotherapeutic intervention that he has designed in order to help terminally ill patients with cancer sustain hope and meaning as they approach the end of their lives. Drawing inspiration and ideas from the works of psychiatrist and Holocaust survivor Viktor Frankl, Dr. Breitbart and his fellow, Dr. Mindy Greenstein, designed an 8-week, group-focused, manualized course of experiential exercises, which is being compared to an 8-week, manualized cancer support group intervention, to see how well meaning-focused care can address a constellation of constructs that he and his colleagues are calling “despair at the end of life.” The component constructs of despair at the end of life include hopelessness, depression, loss of meaning, suicidal ideation, and desire for hastened death. In the following interview with Innovations Associate Editor Karen S. Heller, Dr. Breitbart describes the conceptual evolution of his thinking about despair at the end of life, and details the research on meaning-centered psychotherapy in which he is now engaged. Although the study is still ongoing, preliminary findings suggest that although both types of group intervention reduce patients’ psychological distress and depression and enhance social support, the meaning-centered intervention is more effective in increasing spiritual well-being and a sense of meaning, and in reducing hopelessness and desire for death.

Effects of a computerized system to support shared decision making in symptom management of cancer patients: preliminary results

Objective(1) To evaluate preliminary effects of a computerized support system on congruence between patients' reported symptoms and preferences and those addressed in the patient consultation and (2) to investigate the system's ease of use, time requirements, and patient satisfaction. DesignFifty-two patients were randomly assigned to intervention or control conditions. MeasurementsCancer patients scheduled for an outpatient visit used the system on a tablet computer to report their symptoms and preferences prior to their consultation. This information was processed, printed, and provided to the patient and clinician in the subsequent consultation in the experimental group but not in the control group. ResultsWhile patients in both groups were equivalent at baseline in symptom characteristics, there was significantly greater congruence between patients' reported symptoms and those addressed by their clinicians in the experimental group. The system scored high on ease of use. There were no significant group differences in patient satisfaction. ConclusionThis study provided beginning evidence that eliciting patients' symptoms and preferences and providing clinicians with this information prior to consultation can be an effective and feasible strategy to improve patient-centered care.

Psychiatric aspects of symptom management in cancer patients (clinical practice #25). Edited by WILLIAM BREITBART, M.D. and JIMMIE HOLLAND, M.D. American Psychiatric Press, Inc., Washington, DC, 1993. Price: US$31.00. no. of pages: 278

Psychiatric aspects of symptom management in cancer patients (clinical practice #25). Edited by W<scp>ILLIAM</scp> B<scp>REITBART</scp>, M.D. and J<scp>IMMIE</scp> H<scp>OLLAND</scp>, M.D. American Psychiatric Press, Inc., Washington, DC, 1993. Price: US$31.00. no. of pages: 278

Psychiatric Aspects of Symptom Management in Cancer Patients

Back to table of contents Previous article Next article ArticleNo AccessPsychiatric Aspects of Symptom Management in Cancer PatientsPEDRO RUIZPEDRO RUIZSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.150.8.1267AboutSections ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Psychiatric Aspects of Symptom Management in Cancer Patients." American Journal of Psychiatry, 150(8), p. 1267 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByNone Volume 150Issue 8 August 1993Pages 1267-1267 Metrics History Published online 1 April 2006 Published in print 1 August 1993