Terminally-ill Cancer Patients Research Articles

Latest pain management for painful bony metastases

Pain management for painful bony metastases is the most important problem for symptom relief of terminally-ill cancer patients. Pathological fractures often decrease the activity of daily life (ADL) of patients, and cause deterioration of the quality of life (QOL) and prognosis. Basically pharmacological therapies of the World Health Organization (WHO) method are essential for symptom relief from cancer pain. This article provides the latest pain managements (palliative irradiation, bisphosphonate, orthopedic surgery, percutaneous vertebroplasty and radiopharmaceutical therapy) of bony metastases, and mentions the indications and the problems of these interventions. In consideration to prognosis, the QOL and patient's needs, medical staffs have to perform multidisciplinary approach for providing suitable palliative care.

Congruence of Knowledge, Experiences, and Preferences for Disclosure of Diagnosis and Prognosis between Terminally-Ill Cancer Patients and Their Family Caregivers in Taiwan

Background. Over the last 40 years, studies have shown cultural differences in attitudes toward truth telling at the end-of-life. Nevertheless, the argument that cancer patients from an Asian culture have different preferences about information disclosure that necessitate significantly modifying information disclosure practices has not been validated by direct investigation from patients' points of view. Methods. Six hundred seventeen dyads of patient-designated family caregivers across 21 hospitals throughout Taiwan were surveyed and interviewed by a semistructured interview guide. Percentage of agreement, kappa coefficients, McNemar tests, and paired t-tests were conducted to examine the extent of congruence of knowledge, experiences, and preferences for disclosure of diagnosis and prognosis between the dyads. Results. There were substantial discrepancies in the knowledge and experiences of being informed about the diagnosis and prognosis between Taiwanese terminally-ill cancer patients and their family caregivers (kappa values ranged from 0.08 to 0.44). Cancer patients strongly proclaimed their superior rights to be informed about their disease over their family and preferred their physicians to inform themselves before releasing any information to their family caregivers. Conclusion. The arguments that cancer patients from an Asian culture (i.e., Chinese/Taiwanese culture) have different preferences regarding being informed of their diagnosis and prognosis and that family members have legitimate superior power in decision making could not be supported by data from this group of terminally-ill cancer patients. Physicians need to respect patients' preferences rather than routinely taking the family's opinions into consideration first in the event of disagreement. Equipped with adequate information, terminally-ill cancer patients from Asia may have better opportunities to make end-of-life care decisions that are in accord with their wishes.

Depressão e ansiedade nos cuidadores de mulheres em fase terminal de câncer de mama e ginecológico

PURPOSE: to evaluate the frequency of anxiety and depression in main caretakers of patients with terminal breast or gynecological cancer. METHODS: for this cross-sectional study, 133 informal caretakers of terminally-ill breast and gynecologic cancer patients were included. Patients were hospitalized for palliative care in the Oncology Clinic of the Centro de Atencao Integral a Saude da Mulher (Campinas, Brasil) from August 2002 to May 2004. Seventy-one of the patients had breast cancer and 62 had gynecological malignancies. Hospital Anxiety and Depression Scale (HAD) was applied to these informal caretakers, in order to detect anxiety and depression, and they were also interviewed to provide additional information regarding their age, gender, religion, relation to patient, current occupation, if they cared for other people, whether their routine had changed and whether other people helped them to care for the patient. Logistic regression was used to calculate the odds ratio (OR) and its confidence interval (CI), used to assess the relationship between the diagnoses of anxiety and depression among the informal caretakers. For multiple analyses, the stepwise criterion for variable selection was used. RESULTS: 43% percent of the patients identified their daughters as their main caretaker, and 24%, their husbands. Most of the caretakers were over 35 years old (63%), 68% were female, 59% were unemployed, 47% cared for another person and 84% referred that his/her routine had changed because of caring. Anxiety was detected in 99 caretakers (74.4%) and depression in 71 (53.4%). Anxiety and depression were strongly correlated (odds ratio 5.6; 95% confidence interval 2.2 to 15.9). Bivariate analysis disclosed that the patients' husbands were less affected by depression, but multivariate analysis revealed that only the fact of being male was related to a lower prevalence of anxiety. CONCLUSION: caring for terminally-ill cancer patients led to high prevalence of anxiety and depression. Only men and the patients' husbands were found to have a lower prevalence of anxiety.

How do cancer physicians say they discuss prognosis with their terminally-ill patients? A survey of ASCO members

8005 Background: Information is lacking about how physicians discuss prognosis (prog) with terminally-ill cancer patients (tcp). Methods: We surveyed medical oncologists’ (med oncs) self-reported behaviors and attitudes regarding prog communication (comm) with their tcp. Following a pre-notification letter, surveys were mailed to a systematic sample of 1,222 med oncs with U.S. addresses listed in the 2004 ASCO Members Directory. Results: Surveys were mailed with a $25 gift card in November, 2004. With completed surveys still arriving, 559 surveys have been completed and returned (46% response rate). A second mailing for non-responders is planned. Median age of respondents (res) is 52 (34–80); 84% men; 54% in group private practice; 12% practice solo; 22% practice in a medical school. Res have practiced a median 19 years (2–50) and see a median 60 (0–250) patients/week. Answering yes or no, 98% of res say their usual practice is to tell their tcp they will eventually die of their disease. Choosing from closed-ended responses: 43% say they always discuss prog, 32% discuss prog only after asking their tcp if they want the information, and 14% discuss it only if their tcp ask for the information. 43% say they always or usually communicate a timeframe as to when death may occur and 57% sometimes, rarely, or never give a timeframe. If they do not tell a tcp their prog, 21% always, 27% usually, 20% sometimes, and 19% rarely or never tell family or friends. 93% are always or usually satisfied with their prog comm. 92% say their tcp are always or usually satisfied with the comm. 97% believe prog comm education should be part of cancer-care training. 66% say such education was either absent or inadequate during their training. Qualitative data has also been collected about: clinical factors influencing med oncs’ prog comm, associated emotions, and examples of recent prog comm. Conclusions: Most med oncs say they do not communicate an estimated survival time to their tcp. However, they believe in the need to either discuss the terminal nature of their tcp’ prog or at least respect tcp’ preferences for such information. While nearly all believe prog comm education is needed, the vast majority say they are satisfied with their own comm practices. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Vitas Hospice

Spouse caregivers of terminally-ill cancer patients as cancer patients: A pilot study in a palliative care unit

It is known that families of terminally-ill cancer patients show levels of emotional and functional disruption and are called "second order patients," however, little is actually known about the health problems of family members, especially in terms of cancer. This study reviewed the family histories of terminally-ill cancer patients in a palliative care unit and investigated cancer related health problems of the spouses of terminally-ill cancer patients. We investigated the past medical history of 125 spouses of terminally-ill cancer patients and found that five spouses had a past medical history of cancer. In these five spouses, the duration of illness, present status of treatment and physical condition were reviewed from the database. Of these five spouses, three patients continued to attend an outpatient clinic regularly for checkup and one patient was hospitalized for nephrectomy. Two spouses did not have physical symptoms that made them unable to provide direct care for the terminally-ill spouses, while three could not provide care because of their own physical symptoms derived from cancer. Our findings indicated that some of the spouses of terminally-ill cancer patients are not only "second order patients" but also "cancer patients." Our findings also suggest that some spouses of terminally-ill cancer patients might experience distress both as a cancer patient and as a spouse and may need care both as a cancer patient and as a spouse.

Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients

The importance of spirituality in coping with a terminal illness is becoming increasingly recognised. We aimed to assess the relation between spiritual well-being, depression, and end-of-life despair in terminally-ill cancer patients. 160 patients in a palliative care hospital with a life expectancy of less than 3 months were interviewed with a series of standardised instruments, including the functional assessment of chronic illness therapy-spiritual well-being scale, the Hamilton depression rating scale, the Beck hopelessness scale, and the schedule of attitudes toward hastened death. Suicidal ideation was based on responses to the Hamilton depression rating scale. Significant correlations were seen between spiritual well-being and desire for hastened death (r=-0.51), hopelessness (r=-0.68), and suicidal ideation (r=-0.41). Results of multiple regression analyses showed that spiritual well-being was the strongest predictor of each outcome variable and provided a unique significant contribution beyond that of depression and relevant covariates. Additionally, depression was highly correlated with desire for hastened death in participants low in spiritual well-being (r=0.40, p<0.0001) but not in those high in spiritual well-being (r=0.20, p=0.06). Spiritual well-being offers some protection against end-of-life despair in those for whom death is imminent. Our findings have important implications for palliative care practice. Controlled research assessing the effect of spirituality-based interventions is needed to establish what methods can help engender a sense of peace and meaning.

The ESDQ: A New Method of Assessing Emotional and Social Dysfunction in Patients Following Brain Surgery

The Emotional and Social Dysfunction Questionnaire (ESDQ) has been designed to overcome some of the difficulties of inappropriately applying psychiatric based questionnaires to brain-damaged populations. Two-hundred and twenty-five patients were assessed following brain surgery (BS) using a self-rating patient version of the ESDQ and 211 of these patients were rated by their partner. A factor analysis using a varimax rotation and principal components analysis found the partner results to show eight factors including, Anger, Helplessness, Emotional Dyscontrol, Indifference, Inappropriateness, Fatigue, Maladaptive behaviour, and Insight. The analysis of the Self-rating questions revealed a similar profile, Anger, Emotional Dyscontrol, Helplessness, Inertia, Fatigue, Indifference, Inappropriate, and Euphoria. The scales based on the factors were subjected to discriminant analysis in which the BS patients were compared with a combination control group of neurosurgical outpatients and terminally-ill cancer patients, all of which were without cerebral complaints. The brain surgery results for the partner-rated and the Self-rated version of the ESDQ were compared with control ratings of 42 partners and 54 self-ratings, respectively. The analysis showed a significant discrimination for the Partner-rated version on each of the eight scales individually with an overall significant overall separation (Wilks ?=.903, ?=21.1, df =8, p = <.005). The Self-rated version showed less separation on an individual scale basis the Emotional Dyscontrol scale failing to show a significant separation. The overall difference on the Self-rating version was significant [Wilks ?=.908, ?=26.2, df =8, p = <.001). The levels of internal consistency of the questionnaire scales were found to be satisfactory (Alpha, .78 - .94). Also the relationship between ESDQ scales and standardised measures of aggression, anxiety, depression, and vigour (STAXI, HADS, and POMS) gave an indication of acceptable levels of concurrent validity.

Work with dying patients: Team dynamics and team work1

SUMMARY This paper addresses some issues in palliative-care work that emerged in a short-term staff-support group, and shows that work with terminally-ill cancer patients had an impact on the staff and team as a whole. In dealing with distressing and disturbing feelings related to work with dying patients, the staff used manic defences and denial of differences within the team.

Lung opioid receptors: Pharmacology and possible target for nebulized morphine in dyspnea

Opioid receptors are located throughout the respiratory tract. Yet, these have received relatively scant attention compared to other opioid receptors. The most abundant sites within the respiratory tract appear localized within the alveolar walls, other sites appear to line the smooth muscle within the trachea and main bronchi near the lumen. There is about 100-times greater [ 3H]morphine binding density within the bronchioles and lobes than in the main bronchi or trachea. In addition to the usual μ, δ and κ types of opioid receptors, ‘non-conventional’ opioid binding sites have been suggested, although the function of these or of the other opioid receptors in the pulmonary tract is not known. However, they might explain the otherwise counterintuitive apparent utility of morphine treatment of dyspnea. Dyspnea is a common and distressing symptom in terminally-ill cancer patients and patients with chronic lung disease. It results from multiple causes, is difficult to treat and is a significant precipitating factor for late-stage hospital or hospice admissions. Nebulized morphine or other opioids have been reported to have beneficial effect, but the mechanism by which opioids might produce this seemingly contradictory effect is not clear. We review here lung opioid receptor distribution, pharmacology and possible clinical relevance in the treatment of dyspnea.

Contributing Factors to Physical Symptoms in Terminally-Ill Cancer Patients

Prediction of future suffering could improve palliative care. To identify the factors contributing to physical symptoms, a prospective study was performed on two series of hospice inpatients with cancer ( n = 150 and n = 200, respectively). Physical symptoms, patients' characteristics, and tumor locations were recorded using a structured protocol on admission and throughout the clinical course. Common symptoms on admission and during the patient's course were pain (65%, 88%), general malaise (58%, 77%), anorexia (57%, 94%), constipation (33%, 71%), dyspnea (33%, 66%), nausea/vomiting (29%, 48%), cough/sputum (29%, 48%), edema (27%, 65%), fever (26%, 70%), abdominal swelling (26%, 42%), and dry mouth (25%, 61%), respectively. The mean number of symptoms was 5.7 ± 3.0 on admission and 9.6 ± 3.1 during the course. Factors that contributed to the symptoms were young age (pain, abdominal swelling, dry mouth), performance status (anorexia, general malaise, edema, dyspnea), brain tumor (paralysis), neoplasms of lung/pleura (dyspnea, cough/sputum, death rattle), bone metastasis (pain, paralysis), gastric/pancreas cancer (abdominal swelling), peritoneal metastasis (general malaise, edema, nausea/vomiting, abdominal swelling, dry mouth), opioids (constipation, dry mouth, myoclonus), anticholinergics (dry mouth), and antidopaminergics (myoclonus). Opioid requirement was positively correlated with the presence of bone metastasis, and negatively correlated with age and brain involvement. Additional opioids were frequently used in the final 48 hours in cases with lung/pleura neoplasms. These data suggest that terminal symptoms in cancer patients are determined by local and/or general factors. Clinicians can predict the probability of future symptoms from patients' characteristics, general condition, tumor locations, and medications.

Prevalence of psychological morbidity in terminally-ill cancer patients

The aim of this study was to obtain objective data on the type and frequency of psychological and psychiatric problems in terminally ill patients and determine the influence of various factors on prevalence of adjustment disorder (ie., sociodemographics, awareness of the diagnosis, clinical variables, performance status, degree of pain). Between 1990–1993 410 patients attending Gdańsk Hospice were examined. The following results were obtained; 40% showed a normal response to cancer, and, of the remaining 60%, 37% showed psychological morbidity connected with the carcinoma. Better adaptation to the disease was observed in elderly patients who were usually unaware of their medical status. In the group with an organic mental syndrome most were in the final stage of their terminal illness. Adaptation disorders appeared mostly in younger women under 60 years of age, the more highly educated, those with breast cancer and those who were aware of the medical situation. It was noted that such patients made more complaints of severe pain and tended to be less tolerant of pain. This group therefore requires the most intensive emotional support, counselling or psychotherapy.

Analysis of a hospital-based hospice program for terminally ill cancer patients: detailing patient needs to understand complex programs.

The present paper describes a program analysis of a hospitalbased program for terminally ill cancer patients. Using a management information system developed for collaborative use across all psychosocial care providers in the hospital, it was possible to detail program characteristics and patient variables important to the understanding of a complex program.

Evaluation of Staff Support System in a Palliative Care Unit

Very little has been written on the stress of the people working in a palliative care unit for terminally-ill cancer patients. Here are the results of a prospective research conducted at the Notre-Dame Hospital Palliative Care Unit in Montreal, using a self-rated measure of psychological impairment (Langner's scale). This test was applied as soon as the Unit received its first patients. After one year, we found no increase of reported symptoms and we believe these results are attributable to a good preliminary selection and an effective staff support system.

The Influence of Previous Personality on Reactions to Having Terminal Cancer

This study of 60 married, terminally-ill cancer patients, 22 males and 38 females inquired into associations between the descriptions of each patient's personality and state of mind before and during his/her last illness. Previous information concerning character, marriage, and religious traits was obtained through interviews with the patient's spouse. Information about the patient's feelings and reactions during the illness came from interviews with the patient, spouse, and senior nurse. The results deviate from some pre-conceived beliefs. For instance, less stable people did not show appreciably more emotional disturbance during their terminal illness. While the techniques of group investigations have limitations in their application to any particular individual, they do uncover information which is valuable in understanding the emotional state of the terminally ill.