Breathlessness, fatigue, and anxiety are distressing symptoms for patients with advanced lung cancer, however, they are not relieved by palliative RT and are often viewed as neglected areas of clinical practice. This ...Breathlessness, fatigue, and anxiety are distressing symptoms for patients with advanced lung cancer, however, they are not relieved by palliative RT and are often viewed as neglected areas of clinical practice. This paper aims to review def initions of, and explore patients' experiences of, breathlessness, fatigue, and anxiety. Further, it will outline existing approaches, both pharmacological and non-pharmacological, to treat them. Current treatments and perceptions of these symptoms will be discussed in the context of Hong Kong health care service. The review of literature also shows that breathlessness, fatigue and anxiety appears to have similar emotional origins. A contemporary approach of using a common pyschoeducational intervention to treat these symptoms together as a cluster in end of life care will be discussed.展开更多
Objective: We evaluated the effects of palliative radiotherapy for cancer recurrence or metastasis on patient QOL and psychophysiology. Materials and Methods: Sixty seven patients who received palliative radiotherapy ...Objective: We evaluated the effects of palliative radiotherapy for cancer recurrence or metastasis on patient QOL and psychophysiology. Materials and Methods: Sixty seven patients who received palliative radiotherapy between 2014 and 2015 were enrolled. Patient diseases were bone metastasis in 51 patients, lymph node metastasis in 7 patients, brain metastasis in 2 patients, local recurrence in 3 patients, and others in 4 patients. Median irradiated dose was 30 Gy in 10 fractions for palliative radiotherapy. We used the questionnaires EORTC-QLQ-C30 and EORTC-QLQ-C15-PAL to evaluate patient QOL and the Hospital Anxiety and Depression Scale to evaluate patient mental healthcare at the start and at the end of radiotherapy. Results: As compared to scores at the start of radiotherapy, at the end of radiotherapy, NRS and face scale significantly decreased. On the other hand, Eastern Cooperative Oncology Group Performance Status did not show any changes during palliative radiotherapy. In functional scales, average scores of RF2 and EF also improved. In symptom scales, average scores of FA, PA, and SL improved. In bone metastasis group, global health status/QOL, PA, and SL significantly improved. There was relationship between anxiety improvement and QOL improvement after palliative radiotherapy. Nausea and vomiting scores of EORTC-QLQ-C15-PAL were associated with the irradiated volume of palliative radiotherapy for pelvic region. Conclusion: Patient QOL of was improved by palliative radiotherapy regardless of PS. The possibility of palliative radiotherapy having a positive influence on patient psychophysiology was also suggested in younger age.展开更多
Extrahepatic bile duct cancer (EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct. The treatment of choice is surgical resection, but the predominant ...Extrahepatic bile duct cancer (EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct. The treatment of choice is surgical resection, but the predominant pattern of initial treatment failure is locoregional recurrence. Accordingly, adjuvant radiotherapy has been administered after surgical resection based on these rationales. At this time, there is minimal evidence supporting adjuvant radiotherapy, because there have been no phase III trials evaluating its benefit. Relatively small retrospective studies have tried to compare outcomes associated with EBDC treated with or without radiotherapy. We aimed to review studies investigating adjuvant radiotherapy for resected EBDC. Because less than onethird of EBDC cases are amenable to curative resection at diagnosis, other locoregional treatment modalities need to be considered, including radiotherapy. The next aim of this review was to summarize reports of definitive radiotherapy for unresectable EBDC. Patients with advanced EBDC often experience biliary obstruction, which can lead to jaundice and progress to death. Biliary stent insertion is an important palliative procedure, but stents are prone to occlusion after subsequent ingrowth of the EBDC. Radiotherapy can be effective for maintaining the patency of inserted stents. We also reviewed the benefit of palliative radiotherapy combined with the biliary stent insertion. Lastly, we discuss the existing gaps in the evidence supporting radiotherapy in the management of EBDC.展开更多
文摘Breathlessness, fatigue, and anxiety are distressing symptoms for patients with advanced lung cancer, however, they are not relieved by palliative RT and are often viewed as neglected areas of clinical practice. This paper aims to review def initions of, and explore patients' experiences of, breathlessness, fatigue, and anxiety. Further, it will outline existing approaches, both pharmacological and non-pharmacological, to treat them. Current treatments and perceptions of these symptoms will be discussed in the context of Hong Kong health care service. The review of literature also shows that breathlessness, fatigue and anxiety appears to have similar emotional origins. A contemporary approach of using a common pyschoeducational intervention to treat these symptoms together as a cluster in end of life care will be discussed.
文摘Objective: We evaluated the effects of palliative radiotherapy for cancer recurrence or metastasis on patient QOL and psychophysiology. Materials and Methods: Sixty seven patients who received palliative radiotherapy between 2014 and 2015 were enrolled. Patient diseases were bone metastasis in 51 patients, lymph node metastasis in 7 patients, brain metastasis in 2 patients, local recurrence in 3 patients, and others in 4 patients. Median irradiated dose was 30 Gy in 10 fractions for palliative radiotherapy. We used the questionnaires EORTC-QLQ-C30 and EORTC-QLQ-C15-PAL to evaluate patient QOL and the Hospital Anxiety and Depression Scale to evaluate patient mental healthcare at the start and at the end of radiotherapy. Results: As compared to scores at the start of radiotherapy, at the end of radiotherapy, NRS and face scale significantly decreased. On the other hand, Eastern Cooperative Oncology Group Performance Status did not show any changes during palliative radiotherapy. In functional scales, average scores of RF2 and EF also improved. In symptom scales, average scores of FA, PA, and SL improved. In bone metastasis group, global health status/QOL, PA, and SL significantly improved. There was relationship between anxiety improvement and QOL improvement after palliative radiotherapy. Nausea and vomiting scores of EORTC-QLQ-C15-PAL were associated with the irradiated volume of palliative radiotherapy for pelvic region. Conclusion: Patient QOL of was improved by palliative radiotherapy regardless of PS. The possibility of palliative radiotherapy having a positive influence on patient psychophysiology was also suggested in younger age.
文摘Extrahepatic bile duct cancer (EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct. The treatment of choice is surgical resection, but the predominant pattern of initial treatment failure is locoregional recurrence. Accordingly, adjuvant radiotherapy has been administered after surgical resection based on these rationales. At this time, there is minimal evidence supporting adjuvant radiotherapy, because there have been no phase III trials evaluating its benefit. Relatively small retrospective studies have tried to compare outcomes associated with EBDC treated with or without radiotherapy. We aimed to review studies investigating adjuvant radiotherapy for resected EBDC. Because less than onethird of EBDC cases are amenable to curative resection at diagnosis, other locoregional treatment modalities need to be considered, including radiotherapy. The next aim of this review was to summarize reports of definitive radiotherapy for unresectable EBDC. Patients with advanced EBDC often experience biliary obstruction, which can lead to jaundice and progress to death. Biliary stent insertion is an important palliative procedure, but stents are prone to occlusion after subsequent ingrowth of the EBDC. Radiotherapy can be effective for maintaining the patency of inserted stents. We also reviewed the benefit of palliative radiotherapy combined with the biliary stent insertion. Lastly, we discuss the existing gaps in the evidence supporting radiotherapy in the management of EBDC.
