Terminal Stage Of Cancer Research Articles

The support to stress by autonomous existence in the terminal stage of cancer, A Case Report

In the terminal stage of cancer, Man becomes sensitive to a spiritual stress as autonomous existence. The stress is caused by the discrepancy between objective situations and subjective feelings and also sense of values. In the terminal stage, it is usually difficult to palliate objective situations of autonomous decline. Therefore, the medical staff should support the change of subjective feelings and sense of values. This time, we experienced two cases who were successfully palliated subjective pain by communications focused on 'the support' and 'the interrelation' to the stress by autonomous existence in the terminal stage of cancer. Case 1 achieved an autonomous recovery of the self by the action 'It entrusts them with the mind-body'. Case 2 achieved an autonomous recovery of the self by clarifying an autonomous concept. In both cases, the stress has been relieved.

Etodolac inhibits interleukin-6 production and improves survival combined with chemotherapy in a colon 26 cachexia model

It has been suggested that inflammatory components, including interleukin (IL)-6 and transforming growth factor (TGF)-β, play an important role in the formation of cancer cachexia. Cyclooxygenase (COX)-2 has been reported to suppress tumor progression and to inhibit production of these inflammatory mediators, and, thus, may not only be effective in preventing cachexia, but also beneficial for survival. Etodolac, one of the selective COX-2 inhibitors, was administered to mice bearing cachexigenic clones of colon 26, together with either one of two doses (5 and 10 mg/kg/day) of 5-fluorouracil. Serum concentrations of IL-6 were measured in each treatment group. In the groups treated with 5-fluorouracil alone, survival and tumor growth were significantly improved with 10 mg/kg/day. In the group with etodolac alone, survival improved, however, tumor growth was enhanced. Combination of 5-fluorouracil (5 mg/kg/day) and etodolac improved survival, and the enhancement of tumor growth seen in the etodolac only group, disappeared. By combining 5-fluorouracil (10 mg/kg/day) with etodolac, positive effects on survival and tumor growth were obtained. Serum concentrations of IL-6 were elevated in tumor-bearing mice and were significantly suppressed by treatment with etodolac. In the group with combined treatment, the suppressive effect on IL-6 was synergistic. Our findings suggest that the potential use of COX-2 inhibitors in combination with chemotherapy might be therapeutically advantageous especially in patients with terminal stages of cancer.

P02-384 - Coping of stress in women in terminal stage of oncological disease

ObjectivesThe study was conducted on the basis of the Department of Palliative Medicine of the Kiev City Oncology Hospital from August 2008 to September 2009.The aim of the study was to identify the psychoemotional condition of women in the terminal stage of cancer and identify key factors that will influence the effectiveness of coping with the stressful situation.MethodsAssessment tools: surveillance, clinical and diagnostic interview, objective psychometric scales and test methods to identify the studied trait. The data were subjected to quantitative analysis with subsequent qualitative interpretation and meaningful generalization.ResultsIt was examined 193 women with cancer diagnosed in the terminal stage of disease. For all patients were characterized by an aesthetic syndrome combined with depressed (34%), anxiety (47%), less hypochondriac (11%) manifestations of depending on personality traits and physical condition. We have identified the following factors that affect the effectiveness of coping with stress, the introduced disease: the ability to control the physical symptoms, especially pain, individual-typological personality characteristics of patients, on the presence of emotional supported by the family.ConclusionsCoping behaviour was better in families of women, which practiced open communication about the illness, maintains the atmosphere of openness, the patient was actively involved in issues concerning the tactics of treatment, symptoms to monitor. Thus, family psychological counselling must be included in the program to help women with cancer in terminal stages of disease.

A Genetically Encoded Bioluminescent Indicator for the Sodium Channel Activity in Living Cells

We have developed a genetically encoded bioluminescent indicator for the Na(+) channel, in which Na(+)-sensitive Gaussia luciferase is fused with the voltage-gated Na(+) channel. This indicator is capable of detecting Na(+) flow through the pores of Na(+) channels. Because of high sensitivity and low background in luminescence assays, the absence of toxicity, and a wide linear dynamic range, this luciferase can be used to generate a novel, genetically encoded Na(+) channel indicator. It may provide a high-throughput screening system for drug discovery against Na(+) channels, which should be useful in controlling lethal cardiac arrhythmias, epileptic seizures, and intolerable pain associated with terminal stages of cancer. It may also offer a system for monitoring the Na(+) channel activity in living cells, which may be useful in illuminating neuronal activity in vivo.

Use of Continuous Intravenous Ketamine for End-Stage Cancer Pain in Children

Children in the terminal stage of cancer may experience intractable pain despite the use of high doses of opioids. The resultant sedating effect of the opioids limits the child's ability to communicate and participate in activities, thereby negatively affecting quality of life. Ketamine, an intravenous (IV) anesthetic with analgesic properties, when used in low doses, may be useful in managing pediatric cancer pain at the end of life. Ketamine can prevent the development of opioid tolerance and provide additional analgesia without an increase in sedating effects. At the authors' institution, 2 children with end-stage cancer were started on continuous infusion low-dose ketamine to help achieve adequate pain control and allow the children to be home and interactive for the last weeks of their lives. Each case illustrates the complexities of achieving and maintaining adequate pain control and promoting care of the child and family in a setting that is most appropriate for them.

To tell or not to tell: attitudes of Chinese oncology nurses towards truth telling of cancer diagnosis

To investigate the attitude of oncology nurses towards whether and how to disclose diagnoses to patients with early-stage cancer or terminal illness. The attitudes of patients and doctors towards the disclosure of cancer diagnosis differed from culture to culture. However, little research has focused on the attitudes of Chinese oncology nurses. Survey. A questionnaire investigating nurses' attitudes towards truth telling was delivered to 243 Chinese oncology nurses. One hundred and ninety-nine (819%) nurses completed the questionnaire. 814% of the nurses reported that patients with early-stage cancer should be informed of the diagnosis, while only 442% believed that patients with terminal illnesses should know the truth (p < 0001). Nurses who preferred truth telling reported that patients with early or terminal stages of cancer should be informed by the doctor in charge (765% vs. 739%, respectively; p > 005), immediately after the diagnosis (759% vs. 795%, respectively) and in a quiet and undisturbed room (809% vs. 705%, respectively; p > 005). Nurses' attitudes towards truth telling of terminal cancer were influenced by their educational level and work experience. Oncology nurses differed in their attitudes towards truth telling of different stages of cancer. Nurses who preferred disclosure reported that cancer patients should be informed by the doctor in charge immediately after the diagnosis and in a quiet and undisturbed room. Many Chinese doctors, patients and their relatives believed that patients with terminal illness should not know their diagnosis. Thus, oncology nurses need additional training to deal with these situations.

Thrombotic Thrombocytopenic Purpura and Bone Marrow Necrosis as the Initial Presentation of Lung Cancer

Thrombotic thrombocytopenic purpura (TTP) is a disseminated form of thrombotic microangiopathy. Although most cases are held to be idiopathic, its association with malignancy is well recognized, and it usually occurs at the terminal stage of cancer. Bone marrow necrosis (BMN) is another rare disorder defined pathologically as the necrosis of myeloid tissue and medullary stroma with preservation of bone. Although hematologic malignancy is the most common underlying disease associated with BMN, it can also be caused by solid tumors. The occurrence of TTP with BMN associated with lung cancer has not been reported in the English literature. First described is a patient with the rare association of TTP and BMN displayed as the first manifestations of a lung cancer.

Development of symptom assessment tool for terminal cancer patients

19634 Background: A symptom assessment is important to control the terminal cancer patients’ symptoms successfully and improve their quality of life. Our research team has developed the objective assessment method for the terminal patients’ symptoms and compared the results with the patient self-reported outcomes using Memorial Symptom Assessment Scale (MSAS). Methods: From September in 2004, the 121 inpatients without anti-cancer therapy in terminal stage of cancer were evaluated in Kangnam St. Mary's Hospital. The 17 common symptoms were graded as four categories; none(0), mild(1), moderate(2), and severe(3) with reference to NCI-CTC and WHO toxicity criteria. An attending physician assessed 17 symptoms at the similar hour every day. Among the inpatients, those who had clear consciousness and could communicate normally were investigated every week to evaluate the frequency and severity of common symptoms and their distress degree using MSAS. Results: Only 54 patients (44.6%) could be examined to evaluate the symptoms by MSAS. However, the symptoms estimated by our assessment tool were less serious in the terms of severity and distress degree than that patients felt actually. This tendency was shown more obviously in the mental symptoms; Drowsiness (p=0.0001), Nervousness (p=0.0001), and Anxiety (p=0.005). However, the physical symptoms had no statistical difference between the results from patients and physician. Conclusions: Patient-reported outcomes using MSAS could be obtained from 44.6% of the inpatients with terminal cancer every week. However, the objective assessment tool to evaluate the common symptoms of terminal cancer patients can be applied for all patients including the incommunicable, every day. Furthermore, this assessment tool may be more suitable for examining the physical symptoms of terminal cancer patients. No significant financial relationships to disclose.

Different attitudes of oncology clinicians toward truth telling of different stages of cancer

To investigate different attitudes of oncology clinicians toward whether and how to disclose diagnosis to patients with different stages of cancer. A questionnaire investigating physician's demographic information and attitude toward truth telling was delivered to 256 Chinese oncology clinicians. Two hundred thirty-two (90.6%) physicians completed the questionnaire. Of these oncology clinicians, 87.5% reported that a patient with early-stage cancer should be informed of the diagnosis, while only 40.5% believed that a patient with terminal illness should know the truth (P<0.001). Physicians who preferred to tell the truth reported that patients with early or terminal stage of cancer should be informed by the doctor-in-charge (81.3 vs 77.7%, respectively; P>0.05), immediately after the diagnosis (83.7 vs 87.2%, respectively), and in a quiet and undisturbed room (63.5 vs 68.1%, respectively; P>0.05). In stepwise multiple logistic regression analyses, no demographic information showed association with truth telling of early-stage cancer. Women doctors [odds ratio (OR), 2.25; 95% CI, 1.31 to 3.89; P=0.004] were more likely than men to want the patient to be informed of the terminal illness. Physicians with cancer relatives (OR, 0.55; 95% CI, 0.31 to 0.97; P=0.04) were less likely than physicians without cancer relatives to want the patient to be informed of the terminal illness. Oncology clinicians differed in their attitudes toward truth telling of different stages of cancer. Physicians reported that the doctor-in-charge should be the ones to disclose the condition of the patient, immediately after the diagnosis, and in a quiet and undisturbed room.

Online exclusive: family satisfaction with perception of and barriers to terminal care in Japan.

To examine how families of patients with cancer perceive and are satisfied with terminal care given in a university hospital and to identify barriers to the best care for patients and proper support for their families. Quantitative, descriptive. A Japanese national university hospital. Convenience sample of 73 family members of deceased patients with cancer (response rate was 55%). Completion of a questionnaire comprised of 23 items, including multiple-choice and open-ended questions. Satisfaction with terminal care, misunderstanding of narcotics use, recognition of disease signs and symptoms, and expectations for terminal care. Ninety percent of respondents were satisfied with nursing care. Eighty percent were satisfied with the information they received at admission, 70% were satisfied at the critical phase, and 63% were satisfied at the end of life. The main expected types of desirable terminal care were pain management and spiritual care. The bereaved had difficulty dealing with patients' pain, dyspnea, and appetite loss. Forty-four patients were treated with narcotics. Fifty-seven percent of the family members of these patients found pain to be the most difficult symptom to deal with. Fifty-eight percent of the respondents believed that if narcotics were used, patients would soon die. Terminal cancer care given in Japanese university hospitals does not appear to be adequate in terms of patients' and families' quality of life. The findings indicate that insufficient current information is given throughout the terminal stage of cancer and patients and their families misunderstand the use of narcotics. Oncology nurses need to consider different cultural backgrounds when offering specific care to patients with terminal cancer. Patients and their families must be educated about the efficacy of narcotics in the care of terminally ill patients with cancer.

Poland: The Status of Pediatric Palliative Care

have allowed for a possibility of active euthanasia in children in the terminal stage of cancer. The majority of responders (60%) felt professionally unprepared to work with incurably sick (dying) children and their families. This feature more frequently (85%) occurred in physicians and nurses with job seniority less than 5 years. Sixty percent of responders experienced symptoms of burnout syndrome, with the same frequency in physicians and nurses. The higher risk of burnout was found in those with job seniority over 5 years. Somewhat more than half (56%) of responders judged that protection of children against cancer and procedural pain was satisfactory in their departments; 43% of responders expressed contrary opinion. A significant percentage of responders did not mention any method of child’s protection against pain during vein puncture (43%), lumbar puncture (13%), and bone marrow aspiration (11%).

Legal aspects of consent 18: issues relating to euthanasia.

Norah was in the terminal stages of cancer. She lived with her single daughter, Jane, and was being cared for by Macmillan nurses who came to see her daily. She was on a high level of morphine but still suffered considerable pain. A consultant in palliative care visited her to reassess her medication levels, but Norah found that the new medication still left her with considerable discomfort and pain. Norah asked her daughter to help her end her life. What is the law?

Effects of High Dose Opioids and Sedatives on Survival in Terminally Ill Cancer Patients

Concerns that high dose opioids and sedatives might shorten patient survival could contribute to insufficient symptom alleviation for terminally ill cancer patients. To examine the effects of opioids and sedatives prescribed in the final 48 hours on patient survival, a re-analysis of the prospectively collected data was performed on 209 hospice inpatients. Patient characteristics and clinical symptoms were prospectively recorded, and information about the use of opioids and sedatives in the last two days was collected by a chart review. Opioids were prescribed in 82% of the patients, with a median dose of 80 mg oral morphine equivalent (OME)/48 hours. Sixty percent received some sedative medications, mainly haloperidol (43% of total sample, 7.5 mg/48 hours), midazolam (23%, 23mg/48 hours), and hydroxyzine (15%, 50 mg/48 hours). There were no significant differences in survival between the patients who received different doses of opioids (<240, 240–599, and ≥600 mg OME/48 hours) and of benzodiazepines (0, 1–59, and ≥60 mg parental midazolam equivalent/48 hours). Also, the survival of patients with haloperidol, hydroxyzine, and other sedative medications did not differ from those without. Furthermore, an addition of use of opioids and sedatives in the final 48 hours into the multiple regression model for survival prediction achieved no significant increase in predictability. In conclusion, opioids and sedatives used for symptom control in the last days are not associated with patient survival. They are safe and useful medications to palliate severe distress in the terminal stage of cancer when administered with a low initial dosage and adequate titration.

Spiritual Care for Patients in the Terminal Stage of Cancer : Narratives by Nurses in the Hospices/Palliative Care Units

Spiritual Care for Patients in the Terminal Stage of Cancer : Narratives by Nurses in the Hospices/Palliative Care Units

The Meaning of Hope and the Factors Related to Hope for the Patients in the Terminal Stage of Cancer

The Meaning of Hope and the Factors Related to Hope for the Patients in the Terminal Stage of Cancer

Erythropoietin production in anemia associated with experimental cancer

Serum erythropoietin (EPO) concentrations reportedly are depressed in patients with chronic disorders such as cancer, rheumatoid arthritis, and acquired immunodeficiency syndrome. We evaluated serum EPO levels in mice with tumors and found that the EPO response was appropriate for the associated anemia during the major part of the disease process. The levels of the hormone increased as the anemia worsened in association with progression of the disease. The increased EPO levels were comparable to those of controls with a similar degree of experimentally induced anemia. Only during the terminal stages of cancer, when the animals were severely cachectic, were serum EPO concentrations lower than in controls with a similar degree of anemia. These findings suggest that a blunted EPO response in experimental cancer occurs only in association with advanced disease.

中空坐剤を用いた薬物送達システムの臨床応用

Hollow-type suppositories, which have a hollow cavity to accomodate drugs in various forms such as powder and solution, have been given to a number of patients during the past ten years and their usefulness has been confirmed. For example, more than 13, 000 hollow-type suppositories containing morphine, a potent analgesic, have been administered to patients suffering from severe pain in the terminal stage of cancer in various clinical departments of Shinshu University Hospital. This type of suppository is very effective in relieving such pain. The feature that various doses of morphine can be placed within the hollow-type suppository is very useful, when a higher dose is required to extent the desired effect. The hollow-type suppository that contains valproic acid, an antiepileptic, is effective for prophylaxis and management of seizures. This suppository is particularly beneficial for epileptic patients who cannot take medicines orally. Vaginal administration of a hollow-type suppository containing ulinastatin, which decreases the activity of elastase in the cervix of the uterus, was found to be effective in the prevention of imminent abortion, in combination with oral administration of uterine-relaxing agents. Thus, rectal and vaginal administrations of hollow-type suppositories are clinically useful drug delivery systems.

What about Odor in Terminal Cancer?

Daily care involving proximity with a malodorous patient in the terminal stage of cancer has often proved difficult for the caregiver. Whatever the cause of the primary cancer, three sources of noxious odor can exist or coexist: necrosis, superinfection, and perspiration and/or discharge. The proposed treatment calls for a twofold approach: internal or general and external or local. The internal treatment consists mainly of antibiotics and often involves the combined use of two drugs. Local treatment is applied "à la carte" according to the origin of the odors. Wounds, vomiting, diarrhea, and so on can be treated with specific treatments which will be discussed further.

Utilization of therapeutic embolization in haemorrhage caused by carcinoma of the tongue

Selective transcatheter arterial embolization, using Gelfoam, was performed in 2 patients with bleeding from tongue arteries due to carcinoma. Though the patients were in poor general condition, being in the terminal stage of cancer, there were no complications and the bleeding was successfully controlled. This method was effective in controlling haemorrhage from the tongue due to carcinoma of the tongue.

合成ウナギカルチトニンの血清カルシウム低下作用によく反応した舌癌患者の高カルシウム血症の１症例

Oral tumors are occassionally associated with hypercalcemia. Systemic symptoms due to hypercalcemia cause not only physical and mental troubles to patients but difficulties to physicians in choice of therapy and in prediction of prognosis since these symptoms resemble those seen at terminal stage of cancer. In the treatment of malignant hypercalcemia, simple, safe and efficient therapy that even cachectic cancer patients are able to toleate should be promptly performed.In the case reported here, a patient with tongue cancer diagnosed histologically squamous cell carcinoma, who manifested prominent hypercalcemia at a terminal stage of his clinical course was treated with synthetic eel calcitonin (Elcitonin). Administration of drug at a dosage of 160 MRCU/day intramusculary resulted in a significant decrease in serum calcium levels without notable side effects. Coadministration of glucocorticoid (Solu-Medral 250 mg/day) enhanced the effect of calcitonin.We, therefore, suggest that calcitonin with its known inhibitory action on bone resorption is one of the safest and most efficacious drugs for the treatment of hypercalcemia associated with oral cancers.