[Asthenia in advanced cancer and the use of psychostimulants]. / Astenia en cáncer avanzado y uso de psicoestimulantes.

Asthenia is the most frequent symptom in patients with advanced cancer and is probably what most affects the quality of life of oncology patients since it interferes in their physical and social activity. Treatment in the majority of cases is symptomatic. There is growing interest in the use of psychostimulants for treating asthenia. Methylphenidate and modafinil are two psychostimulants that have already been tested in controlled studies on asthenia of the patient with advanced cancer; they have proved to be efficient, particularly in patients in very advanced stages who are very tired.

Estudio sobre el Síndrome de Burnout en Profesionales de Enfermería de Cuidados Paliativos del País Vasco / No disponible

El síndrome de burnout tiene consecuencias devastadoras para losprofesionales y sus pacientes. El trabajo en Cuidados Paliativos (CP)se ha considerado como una fuente potencial de burnout por suscaracterísticas.Objetivo: El presente estudio se llevó a cabo con el fi n de estudiar losniveles y la prevalencia de burnout en profesionales de enfermería deCP, y detectar aspectos que determinen el riesgo de burnout.Material y Método: El estudio se llevó a cabo con una muestra deenfermeras dedicadas a CP y un grupo control de enfermeras de losmismos hospitales y otras unidades de hospitalización. Se diseñó uncuadernillo de recogida de datos con un cuestionario de burnout (MBI),una escala de apoyo social percibido y un cuestionario de satisfacciónlaboral además de una serie de variables sociodemográfi cas.Resultados: Participaron 105 enfermeras en el estudio, 64 de CP. Nose encontraron diferencias signifi cativas entre niveles y prevalencia deburnout en ambos grupos. Un 58(NCP)-62(CP)% presenta cansancioemocional elevado, un 66(NCP)-59(CP)% un nivel importante de despersonalizacióny un 66(NCP)-70(CP)% una baja realización personal.El porcentaje de enfermeras en el rango de los valores normativos paraBurnout es algo menor en paliativos que en el resto (33% vs 41%):Sin embargo las diferencias no alcanzan signifi cación estadística. Unade cada tres profesionales de enfermería se encuentra dentro de loslímites normales de burnout (33%), otra se encuentra quemada (34%)y la tercera se puede considerar muy quemada (33%), con dos o tresfactores alterados. La falta de formación está relacionada con un mayorcansancio emocional (p≤0.003) y una menor realización personal(p≤0,031). Se observa una mayor satisfacción en las enfermeras deCP, con diferencias estadísticamente signifi cativas(AU)

Burnout Syndrome has devastating consequences in patients andhealth care professionals. Palliative Care (PC) work, because of itscharacteristics, has been considered a potential source of burnout.Objective: The purpose of this study was to determine the levels andprevalence of burnout in palliative care nurses and to evaluate riskfactors of burnout.Methods: The study was conducted with a sample of PC nurses anda control group of non PC (NPC) nurses from the same hospitals.Major measures included the Maslach Burnout Inventory (MBI), aperceived social support scale, a work satisfaction questionnaire andsociodemographic variables.Results: One hundred and fi ve nurses were included in this study,out of which sixty-four (61%) belonged to the PC group. Signifi cantdifferences in levels and prevalence of burnout were not found betweenthe two groups studied. In the MBI, 58(NPC)-62(PC)% have highemotional exhaustion, 66(NPC)-59(PC)% high depersonalization and66(NPC)-70(PC)% low personal accomplishment. One out of threenurses is below the regular limits of burnout, another one has burnoutand the third one has high levels, with two or three burnout factorsaltered. The lack of training is related to higher emotional exhaustion(p≤0,003) and lower personal accomplishment (p≤0,031). A bettersatisfaction in PC nurses is observed.Conclusions: The burnout levels in the nurses studied have been foundto be similar in both groups and higher than the normative scoresof Spanish nurses. PC nurses are more satisfi ed and perceive moresupport in some aspects. The experience acts as a protective factoragainst emotional exhaustion. Nurses perceive lack of specifi c trainingand communication skills. It is necessary to study selection and trainingprocesses of nurses to prevent burnout in this population(AU)

Desarrollo de un Curso Monográfico de Investigación en Medicina Paliativa. Declaración del Castillo de la Mota / Course on Palliative Medicine Research. Declaration of La Mota Castle

Este artículo presenta el planteamiento y algunos resultados del III Curso Monográfico de Investigación en Medicina Paliativa, organizado por elMáster de Medicina Paliativa de la Universidad de Valladolid y celebrado a lo largo de un fin de semana en mayo de 2004. Esta reunión se adapta a una serie de recomendaciones prácticas sobre la organización de cursos de formación avanzada de medicina paliativa en base a la experiencia docente de los autores. En el curso participaron 61 médicos, la mayoría profesionales de equipos de Cuidados Paliativos y, como docentes, varios profesores con dilatada experiencia en investigación clínica de España y otros países. Las actividades desarrolladas fueron de tipo muy diverso, desde presentaciones formales sobre metodología de la investigación aplicada a Cuidados Paliativos y sobre problemas clínicos especialmente debatidos, hasta tertulias abiertas o reuniones de trabajo en pequeños grupos. Al final del curso se realizó una evaluación por parte de los asistentes. Los resultados de la valoración global y de todos los contenidos formales resultaron homogéneamente altos (8-9 sobre 10). Finalmente, el trabajo incluye, en nombre de todos los participantes en el curso, la Declaración del Castillo de la Mota sobre la importancia dela investigación en Cuidados Paliativos en España (AU)

This article presents the characteristics and some results of the 3rd Monographic Course on Palliative Medicine Research organized within the Master on Palliative Medicine of the University of Valladolid. The one weekend long course was carried out in May, 2004. This meeting follows the necessary characteristics that an advanced training course in Palliative Medicine must have in the experience of the authors. In the course participated 61 doctors, most of them professionals in Palliative Care Teams, as well as professors with an extended experience in clinical research both in Spain and abroad. The different activities that were carried out included formal presentations on research methodology applied to Palliative Care, other sessions on clinical problems the special interest, get-togethers and small discussion groups. At the end, the course was evaluated by the participants. The overall assessment of the course as well as the score of its content were homogeneously high (8-9 out of 10). The article also includes on behalf of all the participants in the course, the Declaration of la Mota Castle on the importance of research on Palliative Care in Spain (AU)

Quimioterapia y paliación en enfermos con cáncer avanzado / Chemotherapy and palliation in advanced cancer patients

La quimioterapia es un tratamiento efectivo en numerosos cánceres avanzados. Sin embargo, sus efectos secundarios pueden ensombrecer el beneficio de la respuesta antitumoral. A la hora de valorar la indicación de este tratamiento es preciso conocer la sensibilidad del tumor al tratamiento, los efectos secundarios y el beneficio que se espera obtener, sobre todo expresado como: alivio de síntomas o retraso en su aparición, mejoría de la calidad de vida, aumento de la supervivencia y reducción del volumen tumoral. También es necesario tener en cuenta el estado general y funcional del enfermo, el pronóstico, la sintomatología y su interés en recibir un tratamiento oncológico. De acuerdo con estos parámetros se puede individualizar el esquema terapéutico y seleccionar aquellos pacientes en los que es mayor la expectativa de beneficio por el efecto paliativo de la quimioterapia (AU)

[Chemotherapy and palliation in patients with advanced cancer]. / Quimioterapia y paliación en enfermos con cáncer avanzado.

Chemotherapy shows antitumoral activity in several advanced cancers. However, toxicity is frequent and may even overwhelm the clinical benefit of antineoplastic activity. To recommend such a treatment, we need to know the sensibility of cancer to therapy, its toxic effects and the clinical benefit we are looking for, expressed as: symptoms relief or delay in its presentation, improvement in quality of life, increase in overall survival and reduction in tumor volume. We need also to evaluate the performance status and functional status of each patient, its prognosis, the severity of symptoms and its interest to receive any antitumor treatment. According to these parameters we can individualize each therapy to select those patients whose expected benefit from this palliative chemotherapy is higher.

[Colony stimulating factors in chemotherapy induced neutropenic fever]. / Factores estimulantes de colonias en neutropenia febril inducida por quimioterapia.

We review the randomized trials published so far comparing the use of colony-stimulating factors (both G-CSF and GM-CSF) as adjunctive care in chemotherapy-induced neutropenic fever. With this treatment a slight one day reduction in duration of neutropenia under 500 neutrophils per mm3 is observed; this effect seems to be more important in prolonged neutropenias. The number of days with fever remain unchanged. No clear benefit expressed as clinical and quality of life improvement or economical saving is proved. According to these results, and as previous recommendation about the use of colony-stimulating factors pointed out, the indications for administration of such cytokines in neutropenic fever are restrictive and its use could be acceptable only in patients with poor prognostic factors.

Intestinal bleeding in disseminated non-small cell lung cancer.

A case of gastrointestinal bleeding in a 40 year old male with NSCLC is presented. Usual diagnostic tools did not reveal the cause of bleeding and a laparotomy was necessary to localise and treat the haemorrhage. Intestinal metastases have been described in 11% of lung cancer but they rarely produce symptoms. However, intestinal metastases may produce gastrointestinal perforation, obstruction and very occasionally bleeding. In fact, the present report is the second case published of gastrointestinal bleeding from lung cancer metastases. In most cases prognosis is poor for these patients with a medium survival of a few weeks. Surgery may palliate selected patients but there is no evidence that chemotherapy is beneficial.

Questioning diagnosis disclosure in terminal cancer patients: a prospective study evaluating patients' responses.

This study attempted to assess the degree of knowledge of the diagnosis, and the attitude towards that information, in a group of terminally ill cancer patients. We also tried to determine the influence of the knowledge of the diagnosis on other patient psychosocial needs. We assessed 97 patients (64 in an oncology service, 33 in a palliative care unit) by means of a semistructured personal interview, and a psychosocial needs questionnaire. Data collected showed that 68% of patients had not been informed of their diagnosis; 60% of this group had a high degree of suspicion of their diagnosis, but 42% of noninformed patients did not want to receive more information. Information on diagnosis appears to be beneficial in establishing satisfactory relationships and communication between patients and relatives and staff. We have tried to answer the most relevant issues related to diagnosis disclosure in our clinical setting, questioning the feasibility of truth telling within our cultural boundaries.