Supportive care in pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) is one of the cancers with poorest prognosis and represents the third leading cause of cancer-related deaths in Western countries. Despite advances in diagnostic procedures and treatment, diagnosis is made in most cases when the disease is locally advanced or metastatic. Supportive care aims to improve symptoms, reduce hospital admission rates, and preserve quality of life. Proper symptomatic management is critical to allow administration of chemotherapy and radiotherapy. Symptomatic management should be accomplished in a multidisciplinary fashion. Its primary aims include relief of biliary or duodenal obstruction, prevention and/or treatment of thromboembolic disease, and control cancer-related pain. Nutritional support and optimal replacement therapy in patients with endocrine and/or exocrine insufficiency, is mandatory. This manuscript highlights the most significant problems faced when caring for patients with advanced PDAC and provides an evidence-based approach to symptomatic management (AU)

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Supportive care in pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) is one of the cancers with poorest prognosis and represents the third leading cause of cancer-related deaths in Western countries. Despite advances in diagnostic procedures and treatment, diagnosis is made in most cases when the disease is locally advanced or metastatic. Supportive care aims to improve symptoms, reduce hospital admission rates, and preserve quality of life. Proper symptomatic management is critical to allow administration of chemotherapy and radiotherapy. Symptomatic management should be accomplished in a multidisciplinary fashion. Its primary aims include relief of biliary or duodenal obstruction, prevention and/or treatment of thromboembolic disease, and control cancer-related pain. Nutritional support and optimal replacement therapy in patients with endocrine and/or exocrine insufficiency, is mandatory. This manuscript highlights the most significant problems faced when caring for patients with advanced PDAC and provides an evidence-based approach to symptomatic management.

Delirium en pacientes oncológicos avanzados ingresados en una unidad de hospitalización de cuidados paliativos / No disponible

Objetivo: determinar la frecuencia de delirium en una Unidad de Hospitalización de Cuidados Paliativos. Conocer las características de los pacientes con delirium, así como los factores desencadenantes, reversibilidad y pronóstico. Método: se incluyeron pacientes ingresados en un sector de la Unidad durante el trimestre febrero-abril 2008 que cumplían al ingreso o durante la hospitalización criterios CAM de delirium. Se revisó la historia clínica de los pacientes seleccionados recogiéndose datos demográficos, tipo de neoplasia y extensión, factores contribuyentes-precipitantes, reversibilidad del cuadro y necesidad de sedación para control sintomático. Resultados: de los 50 pacientes que ingresaron durante el periodo de estudio, 28 (56%) cumplían criterios CAM de delirium. La enfermedad neoplásica estaba diseminada en el 75% de los casos. La etiología metabólico-tóxica fue la más frecuente (82,1%). Fueron exitus 89,2% y la sedación para control sintomático fue necesaria en el 17,9%. Conclusiones: el delirium es un cuadro con elevada frecuencia entre los pacientes oncológicos avanzados. La etiología tóxico-metabólica es lamás frecuentemente identificada. Se asocia a alta mortalidad y baja reversibilidad (AU)

Aim: the aim of this study was to determine the frequency of delirium in a Palliative Care Unit, and to know the characteristics of patients with delirium, as well as its triggers, reversibility and prognosis. Method: we included patients admitted to an area of the Unit during the February-April 2008 quarter, who met the CAM criteria for delirium at admission or during hospitalization. Medical records were revised, collecting demographic data, type of cancer and extension, precipitating factors, reversibility, and need of sedation for symptomatic control. Results: out of 50 patients admitted during the study period, 28 (56%) met the CAM criteria for delirium. The neoplasm was disseminated in 75% of cases. A metabolic-toxic etiology was most frequent (82.1%); 89.2% died, and sedation for symptomatic control was necessary in 17.9%. Conclusions: delirium is highly prevalent among advanced cancer patients. A toxic-metabolic etiology is most frequently identified. It is associated with high mortality and low reversibility (AU)