Abstract
Rajimakers NJH, van Zuylen L, Costantini M, Caraceni A, Clark J, Lundquist G, Voltz R, Ellershaw JE, van der Heide A; OPCARE9: Artificial nutrition and hydration in the last week of life in cancer patients. A systematic literature review of practices and effects. Ann Oncol 2011;22:1478–1486.
The benefits and burdens of artificial nutrition (AN) and hydration (AH) during the final days of life are well known, yet clinicians continue to utilize these modalities. In this review, the authors conducted a literature review on the use of AN and AH in the last days of life of patients with cancer. They systematically searched for English papers in PubMed, CINAHL, PsycInfo, and EMBASE for the years January 1998 through July 2009. Results demonstrated that percentages of patients receiving AN or AH during the last week of life varied from 3% to 53% and from 12% to 88%, respectively. Five studies reported on the effects of AH: two found positive effects (less chronic nausea, less physical dehydration signs), two found negative effects (more ascites, more intestinal drainage), and four found no effects on terminal delirium, thirst, chronic nausea, or fluid overload. No study reported on the sole effect of AN. The authors conclude that providing AN or AH to patients with cancer who are in the last week of life is a frequent practice, although the effects on comfort, symptoms, and length of survival seem limited.
Woelk CJ: Managing hiccups. Can Fam Physician 2011;57:672–675.
Hiccups are an annoying and potentially painful complication of chronic and terminal disease. Chlorpromazine has been the standard treatment for many years, although its efficacy is suspect at best. In this brief case-based review, the author reviews the definition, causes, and treatments for hiccups. While brief, this concise review is highly recommended.
Yusuf SW, Sarfaraz A, Durand JB, Swafford J, Daher IN: Management and outcomes of severe aortic stenosis in cancer patients. Am Heart J 2011;161:1125–1132.
Aortic stenosis (AS) is the most common native valve lesion, affecting 43% of all patients with valvular heart disease, including patients with cancer. Unfortunately, the optimal treatment of severe AS in patients with cancer is unknown. The purpose of this study was to assess the impact of aortic valve replacement (AVR) on survival of patients with cancer with severe AS. The authors studied patients with cancer with severe AS seen between January 2001 and April 2007. Baseline demographics, symptoms, cancer diagnosis, laboratory data, treatment, and outcome were collected. Patients who had AVR were matched with controls who did not have AS. Results demonstrated that of 39,071 echocardiograms performed over the study period, 1299 had AS (3.3%), of which 50 patients (0.13%) were identified as having severe AS. Thirteen patients (27%) underwent AVR and 35 were managed medically. Two patients underwent valvuloplasty and were excluded. Survival was significantly longer in patients with severe AS who underwent AVR and was independent of cancer status or presence of metastases. No difference in survival was found between patients who underwent AVR and matched cancer controls. In a multivariable Cox proportional hazard regression analysis, AVR was the only significant predictor of longer survival (adjusted hazard ratio=0.22, p=0.028). The authors concluded that patients with cancer with severe AS who underwent AVR had an improved survival, regardless of cancer status.
Jones BL, Parker-Raley J, Maxson T, Brown C: Understanding health care professionals' views of family presence during pediatric resuscitation. Am J Crit Care 2011;20:199–208.
Nonmedical presence during cardiopulmonary resuscitation is controversial. In this article, the authors examined the conflicting perceptions that health care professionals hold regarding family presence during pediatric resuscitation. In phase 1 of the study, 137 health care professionals completed a 23-item questionnaire about their views on family presence and their perceptions of their opponents' views on family presence. In phase 2, 12 phase 1 respondents were interviewed about the effects that family presence may have on patients' families and on trauma teams. Results demonstrated that all respondents indicated that legal concerns and risks were important factors during family presence; however, respondents in favor of family presence believed that legal concerns and risks were minimized when patients' families were present whereas respondents who were opposed believed the opposite. Respondents who were opposed assumed that respondents who were in favor of family presence were less sympathetic and concerned about families, trauma teams, and health care providers; respondents in favor of family presence assumed that respondents who were opposed were overly preoccupied with legal concerns and potential risks involved with family presence during pediatric resuscitations. All respondents believed that patients' families and trauma teams are affected by family presence. Specifically, respondents in favor of family presence believed that families and trauma team members are positively affected whereas opponents believed the opposite. The authors concluded that these findings provide a deeper understanding of the views of health care professionals and how these views might affect the delivery of family-centered care.
Mitchell J, Jatoi A: Parenteral nutrition in patients with advanced cancer: Merging perspectives from the patient and healthcare provider. Semin Oncol 2011;38:439–442.
The decision to utilize parenteral nutrition in patients with advanced cancer is difficult, with many variable opinions in the literature. Those who routinely care for cancer patients often confront the challenges of discussing these interventions with patients and their families. In this article, the authors review results from previous randomized controlled trials, published guidelines, and recent work that describes the emotional challenges patients and families face as they make such decisions with their healthcare providers. Questions addressed include whether there are real exceptions to the guidelines of no parenteral nutrition in patients with advanced cancer, does parenteral nutrition actually palliate symptoms, and does parenteral nutrition address the main issues with which advanced cancer patients and their families are contending—namely, the fears and anxieties of cancer?
McQuestion M: Evidence-based skin care management in radiation therapy: Clinical update. Semin Oncol Nurs 2011;27:e1–e17.
In this review article, the author utilized research studies, review articles, and clinical practice guidelines to provide a clinical update on the available evidence for the prevention and management of radiation skin reactions (radiodermatitis). The author notes that in the past 4 years there has been minimal change in the evidence available to guide decisions and practice in the management of radiation skin reactions. There continues to be insufficient evidence in the literature to recommend a variety of topical or oral agents in the prevention of skin reactions. There have been some recent studies that have impacted decision making and ecommendations in the management of skin reactions. Radiation treatment techniques are the most promising intervention in reducing the degree of skin reaction. The use of calendula cream may reduce the incidence of grade 2 or 3 reactions in women with breast cancer. The controversy related to the use of deodorant in the treatment field unfortunately continues in clinical settings, but deodorant use as part of routine hygiene is now recommended for practice. Clearly, further research is required to evaluate specific interventions in both the prevention and management of radiation dermatitis.