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1.
Int J Nurs Stud ; 155: 104772, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38676991

RESUMO

BACKGROUND: Recruiting advanced cancer patients is crucial for nursing research in cancer care. However, nurse researchers often face various socio-cultural challenges, particularly in mainland China, where cultural taboos around death pose significant obstacles. An unexplored constraint in this context is the pivotal role Chinese family members play in patients' healthcare decision-making. This research gap underscores the need for a deeper understanding of Chinese family members' perspectives on the engagement of advanced cancer patients in nursing research. OBJECTIVE: To explore the perceptions and concerns of family members regarding the recruitment and participation of advanced cancer patients in nursing research. DESIGN: A qualitative descriptive study was conducted. SETTINGS: Three cancer hospitals in mainland China. PARTICIPANTS: A purposive sample of 18 family members, consisting of children or spouses of advanced cancer patients, was recruited as participants. METHODS: Semi-structured interviews were conducted to collect data between September 2022 and January 2023. The thematic analysis method was used to analyze the data. RESULTS: Three themes were identified: The absence of prior participation, Family members' reluctance to facilitate patient involvement, and Strategies to encourage patients' future participation. Family members were hesitant to allow their relatives with advanced cancer to engage in nursing research, primarily due to concerns about distressing patients, the use of potential sensitive language, stigma, and the risks involved in participation. To address these concerns, they emphasized the importance of gaining family approval prior to patient enrolment. They highlighted the need of family involvement on behalf of sick relatives in research, advocating for the inclusion of a wide range of patients rather than targeting specific subgroups. They also reiterated the significance of choosing the right time for participation and avoiding using sensitive terms such as 'cancer', 'dying', and 'death' when engaging with patients. Moreover, they proposed the recruitment of patients by trusted professionals, shortening the duration of research activities and simplifying research procedures. CONCLUSIONS: This study provides fresh insights into the perspectives of family members concerning the recruitment and engagement of advanced cancer patients in nursing research. It emphasizes the importance of addressing their concerns and recommendations, aiding nurse researchers in developing culturally sensitive recruitment strategies and fostering the inclusive participation of advanced cancer patients in nursing research within the context of family-centered care and cultural taboos surrounding death.


Assuntos
Família , Neoplasias , Pesquisa em Enfermagem , Pesquisa Qualitativa , Humanos , Família/psicologia , Neoplasias/psicologia , Neoplasias/enfermagem , Feminino , Pessoa de Meia-Idade , Masculino , Adulto , China , Participação do Paciente/psicologia , Idoso
2.
BMC Palliat Care ; 23(1): 102, 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38627698

RESUMO

BACKGROUND: Advanced cancer patients with good Eastern Cooperative Oncology Group (ECOG) performance status (score 0-1) are underrepresented in current qualitative reports compared with their dying counterparts. AIM: To explore the experiences and care needs of advanced cancer patients with good ECOG. DESIGN: A qualitative phenomenological approach using semi-structured interview was employed. Data was analyzed using the Colaizzi's method. SETTING/PARTICIPANTS: Purposive sample of terminal solid cancer patients on palliative care aged 18-70 years with a 0-1 ECOG score were recruited from a tertiary general hospital. RESULTS: Sixteen participants were interviewed. Seven themes were generated from the transcripts, including experiencing no or mild symptoms; independence in self-care, decision-making, and financial capacity; prioritization of cancer growth suppression over symptom management; financial concerns; hope for prognosis and life; reluctance to discuss death and after-death arrangements; and use of complementary and alternative medicine (CAM) and religious coping. CONCLUSIONS: Advanced cancer patients with good ECOG have distinct experiences and care needs from their dying counterparts. They tend to experience no or mild symptoms, demonstrate a strong sense of independence, and prioritize cancer suppression over symptom management. Financial concerns were common and impact their care-related decision-making. Though being hopeful for their prognosis and life, many are reluctant to discuss death and after-death arrangements. Many Chinese patients use herbal medicine as a CAM modality but need improved awareness of and accessibility to treatment options. Healthcare professionals and policy-makers should recognize their unique experiences and needs when tailoring care strategies and policies.


Assuntos
Neoplasias , Humanos , Neoplasias/terapia , Cuidados Paliativos , Prognóstico , Autocuidado , Pesquisa Qualitativa
3.
BMC Palliat Care ; 19(1): 38, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32209096

RESUMO

BACKGROUND: A better understanding of differences between the preferences of the general public and the recommendations of healthcare providers with regard to end-of-life (EOL) care may facilitate EOL discussion. METHODS: The aim of this study was to clarify differences between preferences of the general public and recommendations of healthcare providers with regard to treatment, EOL care, and life-sustaining treatment (LST) based on a hypothetical scenario involving a patient with advanced cancer. This study comprised exploratory post-hoc analyses of "The Survey of Public Attitude Towards Medical Care at the End of life", which was a population based, cross-sectional anonymous survey in Japan to investigate public attitudes toward medical care at the end of life. Persons living in Japan over 20 years old were randomly selected nationwide. Physicians, nurses, and care staff were recruited at randomly selected facilities throughout Japan. The general public data from the original study was combined to the data of healthcare providers in order to conduct exploratory post-hoc analyses. The preferences of the general public and recommendations of healthcare providers with regard to EOL care and LST was assessed based on the hypothetical scenario of an advanced cancer patient. RESULTS: All returned questionnaires were analyzed: 973 from the general public, 1039 from physicians, 1854 from nurses, and 752 from care staff (response rates of 16.2, 23.1, 30.9, and 37.6%, respectively). The proportion of the general public who wanted "chemotherapy or radiation", "ventilation", and "cardiopulmonary resuscitation" was significantly higher than the frequency of these options being recommended by physicians, nurses, and care staff, but the general public preference for "cardiopulmonary resuscitation" was significantly lower than the frequency of its recommendation by care staff. CONCLUSION: Regarding a hypothetical scenario for advanced cancer, the general public preferred more aggressive treatment and more frequent LST than that recommended by healthcare providers.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Opinião Pública , Assistência Terminal/métodos , Assistência Terminal/normas , Adulto , Estudos Transversais , Feminino , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Assistência Terminal/estatística & dados numéricos
4.
Rev Esp Salud Publica ; 932019 Jul 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31346155

RESUMO

OBJECTIVE: Non-scheduled consultation is very frequent among patients with cancer, creating alterations and delays in programmed visits. We describe the incidence of non-scheduled consultations in patients with digestive cancer in our hospital. METHODS: Descriptive, prospective, non-interventional study. In a six-month period (May-December 2017), non-scheduled visits were chronologically recorded in the medical oncology consultation of digestive tumours of Hospital Juan Ramón Jiménez de Huelva. We performed a descriptive analysis of the variables collected through the statistical program G-STAT v.2.0. RESULTS: Patients with colon or rectal cancer generated most consultations (68.63%). followed by pancreatic (9.15%) and gastric (5.23%). Most patients had metastatic or advanced stage cancer (59.87%) and were under palliative or symptomatic treatment (58.82%). The most frequent reason for consultation was clinical symptoms (47.05%). followed by information demand (18.30 %). CONCLUSIONS: Non-scheduled consultations in cancer patients are frequent; they cause interference in scheduled consultations and not always resolved satisfactorily. We propose several measures to reduce the number of non-scheduled consultation in oncology.


OBJETIVO: La demanda de asistencia no programada por parte de los pacientes oncológicos es muy frecuente (1,2) y conllevan alteraciones y retrasos en la actividad ya programada. Describimos la incidencia de consultas no programadas en pacientes con cáncer digestivo de nuestro centro. METODOS: Estudio descriptivo, prospectivo y sin intervención. Se recogieron cronológicamente en un periodo de 6 meses (15 de mayo al 14 de diciembre de 2017) y utilizando como fuente la historia clínica de los pacientes, las visitas no programadas atendidas en la consulta de oncología médica de tumores digestivos del Hospital Juan Ramón Jiménez de Huelva. Realizamos un análisis descriptivo de las variables recogidas mediante el programa estadístico G-STAT v.2.0. RESULTADOS: El mayor número de consultas fue realizado por pacientes con cáncer de colon o recto (68,63%), seguidas por los de páncreas (9,15%) y los gástricos (5,23%). La mayoría de los pacientes tenían un cáncer en situación metastásica o avanzada (59,87%) y estaban recibiendo tratamiento paliativo (58,82%) con quimioterapia o sintomático. El motivo de consulta más frecuente fueron los síntomas clínicos (47,05%), seguido por la demanda de información (18,30 %). CONCLUSIONES: Se constata una alta demanda de asistencia no programada por parte de los pacientes con cáncer digestivo, que interfiere con la asistencia programada y no siempre se resuelve satisfactoriamente. Se proponen varias medidas para reducir el número de estas consultas.


Assuntos
Agendamento de Consultas , Neoplasias do Sistema Digestório/terapia , Utilização de Instalações e Serviços/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Neoplasias do Sistema Digestório/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha
5.
Methods Mol Biol ; 1866: 231-242, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30725419

RESUMO

Methionine (MET) has been shown to be a tumor-selective therapeutic target for cancer, since cancer cells require higher amounts of MET to divide and survive than normal cells. This phenomena is known as MET dependence and is probably due to MET overuse by cancer cells. A pilot clinical trial was initially carried out with non-recombinant METase (METase) produced from Pseudomonas putida and subsequently highly purified. No acute clinical toxicity was observed for any criteria measured in the three patients. The depletion of serum MET started within 30 min of the infusion and was maintained for 4 h after the infusion was completed in patient 1 and patient 2. The lowest serum MET levels were 35% and 19% of the pretreatment level, respectively, in patient 1 and patient 2. Patient 3 received a 10 h i.v. infusion of METase without any sign of side effects. MET was depleted over 200-fold from 23.1 to 0.1 µM by the 10-h infusion of patient 3. No clinical toxicity was observed in any criteria measured in patient 3. Subsequently, another pilot Phase I clinical trial was carried out of serum MET depletion in cancer patients by recombinant METase (rMETase) cloned from Pseudomonas putida and produced in E. coli. Patients with advanced breast cancer, lung cancer, renal cancer, and lymphoma were given a single rMETase treatment at doses ranging from 5000 to 20,000 units by i.v. infusion over 6-24 h. No clinical toxicity was observed in any patient after rMETase treatment. rMETase levels were measured at 0.1 to 0.4 units per ml of serum in the patients which correspond to therapeutic levels in vitro. The lowest serum MET levels in rMETase-treated patients were 0.1% of the pretreatment levels corresponding to approximately 0.1 µM, which also correlates to therapeutic levels in vitro as well as in vivo. The results of the METase and rMETase pilot Phase I clinical trials therefore indicate that i.v. infusion of rMETase is safe and effectively depletes its biochemical target of serum MET, suggesting potential efficacy in future clinical trials.


Assuntos
Liases de Carbono-Enxofre/uso terapêutico , Metionina/sangue , Neoplasias/tratamento farmacológico , Neoplasias/patologia , Liases de Carbono-Enxofre/isolamento & purificação , Liases de Carbono-Enxofre/farmacocinética , Fermentação , Humanos , Infusões Intravenosas , Estadiamento de Neoplasias , Neoplasias/sangue , Projetos Piloto
6.
Palliative Care Research ; : 169-174, 2018.
Artigo em Japonês | WPRIM (Pacífico Ocidental) | ID: wpr-688884

RESUMO

There is a lack of recognition regarding the negative impact of cancer cachexia on advanced cancer patients and their family members. Management of cancer cachexia should address not only patients’ physical problems, but also psychosocial burdens of both patients and their family members. Eating-related distress (ERD) is one of the most representative psychosocial burdens experienced during cancer. Summary points of palliative care and nutritional support for ERD experienced by patients and their family members are described as below. 1) Management strategies should address ERD experienced by patients and their family members. 2) If multimodal treatments reduce the negative impact of cachexia, ERD placed on patients and their family members might be alleviated. 3) The main causes of ERD experienced by patients and their family members are a lack of knowledge about cachexia, unsuccessful attempts to increase body weight, expected occurrence of the patient’s death, and conflicts over food between them. 4) Supportive, communicative, and educational interventions would alleviate ERD of patients and their family members. 5) Palliative care and nutritional support for ERD experienced by patients and their family members needs to be tailored to the severity of the patient’s cachexia, especially in cases of refractory cachexia. Since ERD can change during cancer, palliative care and nutritional support need to be tailored to each advanced cancer patient and their family.

7.
Cancer Chemother Pharmacol ; 79(6): 1257-1265, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28424962

RESUMO

BACKGROUND: This phase I trial evaluated the safety and tolerability of milciclib, an inhibitor of multiple cyclin-dependent kinases and tropomycin receptor kinase A, in combination with gemcitabine in patients with refractory solid tumors. DESIGN: Sixteen patients were enrolled and treated with milciclib at three dose levels (45 mg/m2/day, n = 3; 60 mg/m2/day, n = 3; and 80 mg/m2/day, n = 10) with a fixed dose of gemcitabine (1000 mg/m2/day). Milciclib was administered orally once daily for 7 days on/7 days off in a 4-week cycle, and gemcitabine was administered intravenously on days 1, 8 and 15 in a 4-week cycle. RESULTS: All 16 enrolled patients were evaluable for safety and toxicity. Dose-limiting toxicities, which occurred in only one out of nine patients treated at the maximum dose tested (milciclib 80 mg/m2/day and gemcitabine 1000 mg/m2/day), consisted of Grade 4 thrombocytopenia, Grade 3 ataxia and Grade 2 tremors in the same patient. Most frequent treatment-related AEs were neutropenia and thrombocytopenia. Among 14 evaluable patients, one NSCLC patient showed partial response and 4 patients (one each with thyroid, prostatic, pancreatic carcinoma and peritoneal mesothelioma) showed long-term disease stabilization (>6-14 months). Pharmacokinetics of the orally administered milciclib (~t1/2 33 h) was not altered by concomitant treatment with gemcitabine. CONCLUSION: The combination treatment was well tolerated with manageable toxicities. The recommended phase II dose was 80 mg/m2/day for milciclib and 1000 mg/m2/day for gemcitabine. This combination treatment regimen showed encouraging clinical benefit in ~36% patients, including gemcitabine refractory patients. These results support further development of combination therapies with milciclib in advanced cancer patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias/tratamento farmacológico , Idoso , Antimetabólitos Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/farmacocinética , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Quinases Ciclina-Dependentes/antagonistas & inibidores , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Interações Medicamentosas , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Dose Máxima Tolerável , Pessoa de Meia-Idade , Pirazóis/administração & dosagem , Quinazolinas/administração & dosagem , Resultado do Tratamento , Gencitabina
8.
Palliative Care Research ; : 401-407, 2017.
Artigo em Japonês | WPRIM (Pacífico Ocidental) | ID: wpr-378910

RESUMO

<p>Cancer cachexia is a multifactorial syndrome defined by ongoing loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support. Nutritional treatment is a component of nutritional support, as well as symptom palliation and nutritional counseling. Nutritional treatment, exercise, and pharmacological agents are essential for treating cancer cachexia. In our studies at palliative care units, 76% and 73% of advanced cancer patients and bereaved families, respectively, required nutritional support, and nutritional support was also found to have beneficial effects on selected groups of advanced cancer patients. Our studies also indicated that as chronic inflammation is the underlying cause of cancer cachexia the plasma C-reactive protein (CRP) level might be useful as a prognostic marker/biomarker of advanced cancer. It was suggested that nutritional support based on the mechanism responsible for cancer cachexia is useful during the treatment of cancer cachexia although the evidence for this is not robust, and the CRP level is suggested to be a clinically significant index of the response to such treatment.</p>

9.
Asia Pac J Clin Oncol ; 12(1): e38-46, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23551493

RESUMO

AIMS: Quality of life (QOL) is important for advanced cancer patients. Brief questionnaires are advantageous to reduce patient burden. In large clinical trials, statistically significant small changes can be achieved; however, whether such change is clinically relevant is unknown. The purpose of this study was to determine the minimal important differences (MID) of the European Organisation for Research and Treatment of Cancer quality of life core 15 palliative questionnaire (EORTC QLQ-C15-PAL). METHODS: Patients undergoing palliative radiotherapy completed the EORTC QLQ-C15-PAL at baseline and 1 month later. Anchor and distribution-based assessments were employed to determine the MID associated with this instrument. The anchor of overall QOL was used to determine meaningful change. RESULTS: In all, 276 patients were included in MID calculation. Mean age was 65 years and primary lung, breast or prostate cancers were most common. Statistically significant MID for improvement was seen in emotional functioning and pain (20.9 and 15.6, respectively). MID for deterioration required a 20.4, 24.5, 17.1 and 23.0 change in physical functioning, fatigue, pain and appetite loss, respectively, to constitute meaningful change. Distribution-based estimates of MID were closest to the standard error of measurement. MID for brain and bone metastases patients yielded MID larger than previously determined in the incorporation of all patients. CONCLUSION: Meaningful change in the EORTC QLQ-C15-PAL is important for clinicians to determine the impact of treatment on the QOL of patients and can aid in determining the sample size required for clinical trials. Future studies should investigate MID in subgroups using symptom-specific modules.


Assuntos
Neoplasias/psicologia , Neoplasias/terapia , Medicina Paliativa/métodos , Qualidade de Vida , Inquéritos e Questionários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-441635

RESUMO

This study was aimed to evaluate effects of traditional Chinese medicine ( TCM ) five elements music therapy on the quality of life for both senior and non-senior advanced cancer patients , and improve TCM com-prehensive treatment mode . A total of 170 patients were stratified according to 70-year-old in a randomized controlled trial ( RCT ) with a parallel single-blind design . The ratio of patients among three groups was 2:2:1 . In the experimental group , TCM five elements music was given in the treatment . In the positive control group , western music was used in the treatment . And in the negative control group , no music was given in the treat-ment . The treatment was given for 30 min , 5 times per week . And the observation duration was 3 weeks . The Hospice Quality of Life Index-Revised ( HQOLI-R ) , Karnofsky Performance Scale ( KPS ) and Symptom Diary Score recorded by patients were used in the evaluation . The results showed that when comparing HQOLI-R , KPS and Symptom Diary Score before and after treatment among all advanced cancer patients in each group , there was a significant difference before and after treatment in the TCM five elements music therapy group ( P 0 . 05 ) . It was concluded that TCM five elements music therapy is effective in improving quality of life and subjective symptoms for both senior and non-senior advanced cancer patients . However , the sensitivity of using the Symptom Diary Score as an evaluation index among senior patients still needs to be further proved .

11.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-426934

RESUMO

ObjectiveTo screen the items of Advanced Cancer patient Needs Questionnaire (ACNQ)and develop a short version.MethodsA total of 80 cancer patients of middle and advanced stage were recruited.The items were screened with variation degree method and factor analysis method,combined with clinical meaning of the items.The reliability and validity of newly-development scale were confirmed with new sample of 60 cancer patients.ResnltsThrough statistical methods 12 items were removed from the original scale,forming a short version of Advanced Cancer patient Needs Questionnaire:ACNQ-29.The correlation coefficient of split half reliability was 0.913.The Cronbach′s α coefficient of all items was 0.923.Through principal components and factor analysis,7 principal components were gained including basically the 4 dimensions of physiological,psychological,spiritual and social domain with accumulation contribution of 75.478%.ConclusionsNew scale has good reliability and validity,and more easily for patients to complete.It has feasibility and practicability.

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