ABSTRACT
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Subject(s)
Humans , Female , Aged , Opsoclonus-Myoclonus Syndrome/diagnosis , Opsoclonus-Myoclonus Syndrome/drug therapy , Carcinoma, Small Cell/diagnostic imaging , Carcinoma, Small Cell/pathology , Cisplatin/administration & dosage , Immunosuppressive Agents/administration & dosage , Opsoclonus-Myoclonus Syndrome/physiopathology , Antibodies, NeoplasmABSTRACT
During the clinical evolution of patients with cancer there are many occasions, or phases of the disease, when there are no specific treatments and, as such, we need to provide maximum comfort following appropriate symptom control; in this stage it is fundamental to respect personal autonomy together with the option to reject futile treatment. With appropriate control of symptoms it is possible to reach the stage where the majority of the patients do not continue to suffer. Continuous-care providers for cancer patients are those who are responsible for providing help to resolve these situations. In palliative medicine there are highly-efficacious procedures to the help in these last hours. Sedation is applied when it is impossible to control symptoms by other means. With appropriate Carer cover, it is not necessary to introduce laws on assisted suicide and/or active voluntary euthanasia, neither because of the magnitude of demand, nor because of the difficulties in achieving appropriate control of symptoms.
Subject(s)
Caregivers , Euthanasia , Neoplasms/therapy , Patient Care Team , Terminal Care/methods , Australia , Europe , Euthanasia/legislation & jurisprudence , Euthanasia, Active/ethics , Euthanasia, Active/legislation & jurisprudence , Euthanasia, Active/psychology , Euthanasia, Passive/ethics , Euthanasia, Passive/legislation & jurisprudence , Euthanasia, Passive/psychology , Humans , Japan , Medical Futility , Neoplasms/psychology , Palliative Care , Personal Autonomy , Right to Die/legislation & jurisprudence , Suicide, Assisted/legislation & jurisprudence , Terminal Care/ethics , Terminal Care/legislation & jurisprudence , Terminal Care/psychology , Terminally Ill/psychology , United StatesABSTRACT
La evolución de los enfermos con cáncer conduce en muchas ocasiones a fases de la enfermedad en las que no existen tratamientos específicos y éstos debemos aplicarlos en la consecución del máximo confort a través de un adecuado control sintomático, en esa etapa es fundamental el respeto de la autonomía personal y la posibilidad del rechazo de tratamientos fútiles. Con el adecuado control de síntomas es posible lograr que la mayoría de los enfermos no padezcan sufrimientos. Los cuidados continuos en el paciente oncológico son los responsables de ayudarnos a resolver estas situaciones. En medicina paliativa existe un procedimiento altamente eficaz en la ayuda en las últimas horas, la sedación, aplicable cuando sea imposible el control sintomático con otros medios. Con una cobertura adecuada de cuidados no debería ser necesario introducir leyes de suicidio asistido y/o eutanasia activa voluntaria, ni por la magnitud de la demanda, ni por las dificultades en el adecuado control sintomático
During the clinical evolution of patients with cancer there are many occasions, or phases of the disease, when there are no specific treatments and, as such, we need to provide maximum comfort following appropriate symptom control; in this stage it is fundamental to respect personal autonomy together with the option to reject futile treatment. With appropriate control of symptoms it is possible to reach the stage where the majority of the patients do not continue to suffer. Continuous-care providers for cancer patients are those who are responsible for providing help to resolve these situations. In palliative medicine there are highly-efficacious procedures to the help in these last hours. Sedation is applied when it is impossible to control symptoms by other means. With appropriate Carer cover, it is not necessary to introduce laws on assisted suicide and/or active voluntary euthanasia, neither because of the magnitude of demand, nor because of the difficulties in achieving appropriate control of symptoms
Subject(s)
Humans , Euthanasia/ethics , Right to Die/ethics , Continuity of Patient Care/trends , Palliative Care/trends , Hypnotics and Sedatives/administration & dosage , Suicide, Assisted/legislation & jurisprudence , Euthanasia, Active, Voluntary/legislation & jurisprudenceABSTRACT
INTRODUCTION: Presence of circulating DNA in the serum of patients with cancer makes detection of tumour-specific genetic alterations feasible. OBJECTIVE: To study serum DNA concentration in patients diagnosed as having advanced Non-Small Cell Lung Cancer (NSCLC) and to evaluate its relationship with age, histology, stage, response, time-to-progression (TTP), and survival. METHODS: Serum DNA from 78 patients was purified and spectrophotometrically quantified. RESULTS: No significant correlations were found between serum DNA concentration and age, histology, response and survival. There was a significant correlation with respect to stage (IIIB = 408.75 ng/ml; IV = 478.74 ng/ml; p = 0.02). When patients were grouped according to DNA concentration, significant correlation with TTP was found; establishing a cut-off point at 500 ng/ml ([DNA] < 500 ng/ml TTP = 7.25 months, 95%CI: 3.5-5.25; [DNA ] > or = 500 ng/ml TTP = 4.25 months, 95%CI: 2-6.5; p = 0.05). CONCLUSIONS: Using the present method, DNA concentration quantification appears to be simple, but with certain deficiencies due to inter-sample variability and low specificity. This is because total DNA concentration is measured without distinguishing as to whether it is tumour-related. We suggest that there is a correlation between DNA concentration and prognosis which enables an analysis of the natural history of the disease.
Subject(s)
Carcinoma, Non-Small-Cell Lung/blood , Carcinoma, Non-Small-Cell Lung/genetics , DNA, Neoplasm/blood , Lung Neoplasms/blood , Lung Neoplasms/genetics , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Predictive Value of Tests , PrognosisABSTRACT
Introducción. El ADN sérico de pacientes oncológicos puede permitir detectar alteraciones genéticas específicas del tumor. Objetivo. Estudiar la concentración de ADN sérico ([ADN]) en pacientes con cáncer de pulmón no microcítico (CPNM) avanzado. Evaluar su relación con la edad, histología, estadio, respuesta, tiempo a la progresión (TTP) y supervivencia. Métodos. Se purificó el ADN sérico de 78 pacientes y se cuantificó espectrofotométricamente. Resultados. No hubo diferencias significativas entre [ADN] media y edad, histología, respuesta, y supervivencia. Hubo significatividad respecto al estadio (IIIB= 408,75 ng/ml; IV= 478,74 ng/ml; p= 0,02). Agrupando los pacientes según el [ADN] hubo significatividad en TTP estableciendo un punto de corte en 500 ng/ml ([ADN] = 500 ng/ml, TTP=4,25 meses, IC 95% 2-6,5; p= 0,05). Conclusiones. La cuantificación del ADN sérico resulta sencilla mediante este método, pero presenta deficiencias debido a la variabilidad intermuestral y a la baja especificidad, al medirse el [ADN] total sin especificar su asociación o no al tumor. Nuestro estudio sugiere que el [ADN] está relacionado con el pronóstico permitiendo un análisis evolutivo
Introduction. Presence of circulating DNA in the serum of patients with cancer makes detection of tumour-specific genetic alterations feasible. Objective. To study serum DNA concentration in patients diagnosed as having advanced Non-Small Cell Lung Cancer (NSCLC) and to evaluate its relationship with age, histology, stage, response, time-to-progression (TTP), and survival. Methods. Serum DNA from 78 patients was purified and spectrophotometrically quantified. Results. No significant correlations were found between serum DNA concentration and age, histology, response and survival. There was a significant correlation with respect to stage (IIIB = 408.75 ng/ml; IV = 478.74 ng/ml; p = 0.02). When patients were grouped according to DNA concentration, significant correlation with TTP was found; establishing a cut-off point at 500 ng/ml ([DNA] = 500 ng/ml TTP = 4.25 months, 95%CI: 2-6.5; p = 0.05). Conclusions. Using the present method, DNA concentration quantification appears to be simple, but with certain deficiencies due to inter-sample variability and low specificity. This is because total DNA concentration is measured without distinguishing as to whether it is tumour-related. We suggest that there is a correlation between DNA concentration and prognosis which enables an analysis of the natural history of the disease
