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PubMed1996

[Cholangiojejunostomy of the duct of the 3d segment. Palliative treatment of cholestatic jaundice caused by neoplastic obstruction of the hepatic hilus].

Cholangiojejunostomy of the duct of the III segment in the palliative treatment of mechanical jaundice from neoplastic obstruction of the hepatic hilus. The neoplastic obstruction of the liver hilus has an almost total absence of forewarning clinical signs and therefore results in surgery at a late stage when the patient is not susceptible to radical treatment. It is therefore necessary to use palliative treatment in order to resolve the serious jaundice, the main cause of a quick death. Among the palliative treatment the Authors report their experience of intrahepatic cholangiojejunostomy of the duct of the III segment that they consider the most suitable technique for its ease of execution, its constant anatomical situation and the peripheral position of the anastomoses in relation to the neoplastic lesion. This allows a lasting biliary decompression with a good residual life.

Anastomosis, Surgical↗
PubMed2003

Octreotide for palliative treatment of hepatic metastases from non-neuroendocrine primary tumours: evaluation of quality of life using the EORTC QLQ-C30 questionnaire.

BACKGROUND AND AIM: While octreotide has been used in palliative treatment of hepatocellular carcinoma and neuroendocrine tumours with good results, little is known about the possible role of this in palliative treatment of hepatic metastases. MATERIAL AND METHODS: We present our experience from the use of octreotide in palliative treatment of symptomatic liver metastases in 16 patients (11 males, five females, age ranged 43-69 years) with proven hepatic metastases from different primary tumours (six with non-small lung cancer, four with colon carcinoma, two with primary pancreatic head carcinoma, two with prostate cancer and two with adenocarcinoma of the stomach). All patients were administered 20 mg long-acting octreotide IM (octreotide LAR) once the first day, octreotide SC 0.5 mg three times daily on days 2-14 and then 20 mg long-acting octreotide IM every month. Quality of life was assessed by using the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30). Tumour response was evaluated by using ultrasonography. RESULTS: One month after baseline, octreotide resulted in significant (P < 0.01, Wilcoxon test) improvement and stabilization of all major related EORTC QLQ-C30 parameters such as global quality of life, pain, fatigue, insomnia, appetite loss as well as physical, emotional, cognitive, social and role functioning. Except for mild hyperglycaemia in six out of 16 patients and mild gastrointestinal complications in one patient, no other severe side effect due to octreotide was reported. Two patients died two months after the initiation of the study due to generalized metastatic disease, while the remaining 14 patients were still alive seven months after the initiation of the study. The hepatic metastases were stabilized and no new lesions were detected by ultrasonography. CONCLUSIONS: Although further studies are warranted, we consider the use of octreotide a good alternative in palliative treatment of symptomatic liver metastases in patients with end-stage malignant disease.

Adult↗
PubMed1998

Acute colorectal obstruction: stent placement for palliative treatment--results of a multicenter study.

PURPOSE: To evaluate the usefulness of stent implantation as a palliative treatment in patients with acute colonic obstruction who are not surgical candidates. MATERIALS AND METHODS: Twenty-four patients (eight women, 16 men; age range, 60-98 years) with acute colonic obstruction underwent colonic stent placement. In nine patients, the procedure was considered a primary palliative treatment; seven patients had a previous diagnosis of disseminated neoplastic disease, and two were not surgical candidates because of their poor general condition. In the remaining 15 patients, stent placement was considered the definitive palliative treatment after tumor staging. The mean time of follow-up was 8.4 months (range, 1-24 months) for patients who lived and 6.3 months (range, 1-12 months) for those who died. RESULTS: Stent placement was successful in all patients. Clinical and radiographic findings of bowel obstruction resolved within 24 hours after stent placement in 23 (96%) patients. None of the patients required colostomy for bowel decompression after immediate stent placement. Complications developed in 10 (42%) patients: Two (8%) patients had mild rectal bleeding; three (12%), abdominal pain; two (8%), malpositioning of the stent; two (8%), pseudo-obstructive episodes due to fecal impaction; and one (4%), occlusive tumor ingrowth into the stent lumen. One (4%) patient underwent surgery to resolve stent malfunction due to poor positioning. Two (8.3%) patients--one with malpositioning of the prosthesis and the other with stent occlusion--required a new stent. The remaining complications required no further treatment. The mortality rate at 6 months was 24%. Eight patients were alive at the time this article was written. CONCLUSION: Colorectal stent placement resulted in successful palliation of acute colonic obstruction in patients with disseminated neoplastic disease.

Acute Disease↗
PubMed2001

The patient-physician relationship. Patient-physician communication during outpatient palliative treatment visits: an observational study.

CONTEXT: Improving health-related quality of life (HRQL) is an important goal of palliative treatment, but little is known about actual patient-physician communication regarding HRQL topics during palliative treatment. OBJECTIVES: To investigate the content of routine communication regarding 4 specific HRQL issues between oncologists and their patients and to identify patient-, physician-, and visit-specific factors significantly associated with discussion of such issues. DESIGN: Observational study conducted between June 1996 and January 1998. SETTING: Outpatient palliative chemotherapy clinic of a cancer hospital in the Netherlands. PARTICIPANTS: Ten oncologists and 240 of their patients (72% female; mean age, 55 years) who had incurable cancer and were receiving outpatient palliative chemotherapy. MAIN OUTCOME MEASURES: Patient and physician questionnaires and audiotape analysis of communication regarding daily activities, emotional functioning, pain, and fatigue during an outpatient consultation using the Roter Interaction Analysis System. RESULTS: Physicians devoted 64% of their conversation to medical/technical issues and 23% to HRQL issues. Patients' communication behavior was divided more equally between medical/technical issues (41%) and HRQL topics (48%). Of the independent variables investigated, patients' self-reported HRQL was the most powerful predictor of discussing HRQL issues. Nevertheless, in 20% to 54% of the consultations in which patients were experiencing serious HRQL problems, no time was devoted to discussion of those problems. In particular, these patients' emotional functioning and fatigue were unaddressed 54% and 48% of the time, respectively. Discussion of HRQL issues was not more frequent in consultations in which tumor response was evaluated. CONCLUSION: Despite increasing recognition of the importance of maintaining patients' HRQL as a goal of palliative treatment, the amount of patient-physician communication devoted to such issues remains limited and appears to make only a modest contribution, at least in an explicit sense, to the evaluation of treatment efficacy in daily clinical practice.

Activities of Daily Living↗
PubMed2004

Quality of life after palliative treatment for oesophageal carcinoma -- a prospective comparison between stent placement and single dose brachytherapy.

Metal stent placement and single dose brachytherapy are commonly used treatment modalities for the palliation of inoperable oesophageal carcinoma. We investigated generic and disease-specific health-related quality of life (HRQoL) after these palliative treatments. Patients with dysphagia from inoperable oesophageal carcinoma were randomised to placement of a covered Ultraflex stent (n = 108) or single dose (12 Gy) brachytherapy (n = 101). We obtained longitudinal data on disease-specific (dysphagia score, European Organisation for Research and Treatment of Cancer (EORTC) OES-23, visual analogue pain scale) and generic (EORTC Quality of Life-Core 30 Questionnaire (QLQ-C30), Euroqol (EQ)-5D) HRQoL at monthly home visits by a specially-trained research nurse. We compared HRQoL between the two treatments and analysed changes in HRQoL during follow-up. Dysphagia improved more rapidly after stent placement than after brachytherapy, but long-term relief of dysphagia was better after brachytherapy. For generic HRQoL, there was an overall significant difference in favour of brachytherapy on four out of five functional scales of the EORTC QLQ-C30 (role, emotional, cognitive and social) (P < 0.05). Generic HRQoL deteriorated over time on all functional scales of the EORTC QLQ C-30 and EQ-5D, in particular physical and role functioning (on average -23 and -24 on a 100 points scale during 0.5 years of follow-up). This decline was more pronounced in the stent group. Major improvements were seen on the dysphagia and eating scales of the EORTC OES-23, in contrast to other scales of this disease-specific measure, which remained almost stable during follow-up. Reported levels of chest or abdominal pain remained stable during follow-up in both treatment groups, general pain levels increased to a minor extent. The effects of single dose brachytherapy on HRQoL compared favourably to those of stent placement for the palliation of oesophageal cancer. Future studies on palliative care for oesophageal cancer should at least include generic HRQoL scales, since these were more responsive in measuring patients' functioning and well-being during follow-up than disease-specific HRQoL scales.

Aged↗
PubMed2005

[Decisions around the end of life on Intensive Care: making the transition from curative to palliative treatment].

The decision to move from curative treatment to palliative care in the intensive-care situation is less related to morals and ethics than it is to the assessment of medical issues, professionalism, communication and orchestration. Treatment should be considered medically pointless if, in the view of the treating physicians, it does not offer realistic chance to return to a meaningful life. Continuing futile care can be seen as disrespectful, both to the patient, his partner and the family, as well as to the members of the ICU team. Intensivists are responsible for withholding or withdrawing life support to patients in whom further life support is considered futile and who are unable to express their wishes due to critical illness and sedation. The intensivist typically makes this type of decision after a period in which medical and other information has been collected and after intensive discussions with other medical professionals as well as the partner and family. This is based on the trust that is built up through their skill, attitude and behaviour and that is perpetuated in a continuing process of intensive communication. Conflicts should be prevented, or at least recognised early and discussed. Ifa conflict is ongoing then it should be tackled by planning a number of consecutive consultations.

Decision Making↗
PubMed1987

Palliative treatment of rectosigmoid carcinoma by laser endoscopic photoablation.

Ninety-five patients underwent endoscopic outpatient neodymium:yttrium aluminum garnet or argon laser treatments for palliation (relief of obstruction, control of bleeding or discharge) of rectosigmoid carcinoma at the Lille Multidisciplinary Laser Center. All patients were classified as inoperable because of coincident medical conditions or extent of tumor. Two groups were identified as follows: 10 group 1 patients had exophytic tumors less than 3 cm in diameter, and 85 group 2 patients had more advanced tumors. Local control of the tumor was obtained in all patients in group 1 without complication. Eighty-five percent of group 2 patients were symptomatically improved by the treatment. The survival rate (by life table analysis method) at 24 mo was only 19%, but the percentage of surviving patients who remained symptomatically improved was high [90% (3 mo) to 68% (24 mo)]. Factors influencing improvement or survival rates include the main symptom at the beginning of treatment, reason for choosing laser treatment, and circumferential extent of tumor base. There was one fatal perforation and one perirectal abscess. Laser photoablation was able to locally control small rectosigmoid carcinomas in patients unable to undergo incisional surgery. Laser treatment provided relief of symptoms in inoperable patients with advanced rectosigmoid carcinomas.

Aged↗
PubMed1991

Short-term radiotherapy as palliative treatment in patients with transitional cell bladder cancer.

We report the results and complications of treatment with palliative, short-term radiotherapy in 162 elderly or disabled patients. Improvement in tumour-associated symptoms was noted in 75 of these patients and 72 survived for more than a year. Those who responded to radiotherapy had a 5-year cancer-free survival rate of 58% compared with 4% in patients who did not respond to treatment. Survival was also affected by stage and indications for radiotherapy. In 85 patients without severe symptoms, where the tumour was judged curable but the patient was unsuitable for a full course of radiotherapy, the 5-year cancer-free survival rate was 21%, which is in accordance with what can be achieved with full-course radiotherapy; 42% had various minor acute side effects. The 5-year late complication rate was 7%.

Aged↗
PubMed1996

Strontium-89 chloride (Metastron) for palliative treatment of bony metastases. The University of Minnesota experience.

Strontium-89 chloride (Metastron) is an FDA-approved treatment for palliation of cancer pain. We evaluated blood count changes and pain relief in 28 patients with widespread painful bony metastasis treated with strontium-89 at the University of Minnesota Hospital and Clinics. Eighteen patients had prostate cancer (all hormone-refractory cancer), seven patients had breast cancer, and three patients had lung cancer, all previously treated with either radiation, chemotherapy, or a combination of the two. Serial blood counts were performed weekly up to 8 weeks and at 12 weeks after administering Metastron. Pain scale and blood values were monitored simultaneously. The mean baselines of hemoglobin (Hgb), white blood count (WBC), and platelets (Plts) were 11.4, 5900, and 258,000, respectively. The mean dose of Metastron was 3 mCi (range 2.2-4.4). The median time (range) to nadir was about 6 weeks. The percentage reductions relative to baseline were 32% (range 0-72%) for WBC; 14% (range 0-50%) for Hgb; 15% (range 0-47%) for the red blood cell (RBC) count; and 40% (range 0-85%)for Plts. We did not find a close relationship among the baseline blood count, reduction of subsequent blood counts, or previously irradiated active bone marrow volume. The median time of survival was 23 weeks (range 2-66 weeks). At 12 weeks, 29% of patients had moderate to dramatic improvement of pain, 32% had some relief of pain, and 50% had no improvement in pain. Thirty-two percent of the treated patients required additional palliative external beam radiation to their bony lesions within the study period. Our results show that Metastron for palliation for bony metastases should be used with caution because of moderate to severe bone marrow toxicity, especially in platelets, associated with its use. Careful evaluation of patients given Metastron is needed to assess accurately its full benefit.

Adult↗
PubMed1998

[Endoscopic palliative treatment of tumors of the gastrointestinal tract].

Patients with nonresectable gastrointestinal tumors have a life expectancy of a few months only. Effective palliative treatment has to ensure a good quality of life with minimal morbidity and mortality. Esophageal carcinoma: Endoscopic intubation or stent implantation guarantee a prompt improvement of dysphagia with minimal morbidity and mortality in esophageal carcinoma. Only in cervical or noncircumferential stenosis laser therapy is preferable. Obstructive jaundice: Metal stents offer the best quality of life after palliative treatment of malignant obstructive jaundice. However, in patients with bad general conditions and a short life expectancy a pigtail catheter is less expensive. Colorectal cancer: Laser therapy and cryosurgery offer uncomplicated nonsurgical therapy in rectal carcinoma. Stents in the colorectum have a high complication rate. Endoscopic palliative treatment of gastrointestinal tumors can be performed with minimal morbidity and mortality. However, it is essential that a surgeon is involved in the decisionmaking between endoscopic or operative treatment.

Endoscopes↗
PubMed1983

Has CT scanning a role to play in the radiotherapy planning of palliative treatment?

Radiotherapy is useful in the palliative treatment of many large incurable tumours. This study evaluates the effectiveness of computed tomography (CT) as an adjunct in the radiotherapy planning of these patients. Forty-five patients had their treatment fields simulated using findings from physical examination, x-rays etc. The patients were then scanned under conditions simulating the radiotherapy and the dosimetry was recalculated. CT scanning was found to be valuable in the radiotherapy planning in 56% of the treatment series (field geometry: 27% dosimetry: 46%).

Bone Neoplasms↗
PubMed1995

[Palliative treatment of cancer of the rectum using an urologic prostate resectoscope].

Palliative treatment for patients with rectal carcinoma concerns more than 10% of the 8000 cases diagnosed each year in France. Seventeen patients (median age: 83 years) underwent 27 endoscopic transanal resections using a urological resectoscope. The morbidity was 18.5% and there were no postoperative deaths. The median hospital stay for the procedure alone was 4 days. Local control was obtained in 13 (76%) patients with good palliation of obstruction, bleeding and tenesmus. The mean survival time was six months. This simple, minimally invasive and economic method should be part of palliative treatment for patients with rectal carcinoma together with laser destruction and external beam radiotherapy.

Adenocarcinoma↗
PubMed2001

[Expandable metal stents in palliative treatment of malignant colorectal stricture. A report of 17 consecutive patients].

OBJECTIVE: Several endoscopic procedures have been used to avoid a colostomy in palliative treatment of occlusive colorectal cancer. The aim of this study was to evaluate in intent to treat the long term effectiveness and safety of self-expanding metal stents as a palliative treatment in patients with neoplastic colonic obstruction. PATIENTS AND METHODS: From December 1997 to June 2000, seventeen patients were treated with 21 colonic stents. Sites of obstruction were high rectum in 3, sigmoid in 11 and left colon in 3. RESULTS: Stent placement was successful in 16/17 patients (94%). Relief of bowel obstruction occurred in 13 patients (74%) in the first 48 hours. Expandable metal stent achieved an effective bowel transit until death in 9 of the 17 patients (53%). Clinical complications occurred in 6 patients (35%): 2 perforations, 2 migrations, 1 rectal bleeding and 1 dislocation of the stent. Subsequent colostomy was done in 5 patients. CONCLUSION: Colonic stenting is an alternative palliative treatment in malignant colorectal stricture. However, morbidity and need for subsequent colostomy should be taken into account.

Adult↗
PubMed1997

Role of transanal endoscopic microsurgery in the palliative treatment of rectal cancer.

BACKGROUND: Palliative, minimal invasive treatment of rectal cancer is advocated in patients with advanced and incurable disease or poor clinical condition and in those who refuse radical surgery. Several methods have been used during recent years. We report our experience with palliative transanal endoscopic microsurgery. MATERIALS: Between 1983 and 1995, 29 patients underwent transanal endoscopic microsurgery for palliation. Eleven patients had advanced malignant disease, nine were in poor clinical condition, and nine repeatedly refused radical surgery. RESULTS: Intraoperatively one severe complication, an intra-abdominal perforation, occurred. The morbidity rate was 14%. Postoperatively, clinical signs were abolished or improved in all cases. Only three patients required further palliative resections after initial symptom relief. CONCLUSIONS: Transanal endoscopic microsurgery is a successful approach in the palliative treatment of rectal cancer. The technique enables complete resection of rectal tumors. Although anesthesia is needed, the morbidity is low, even in patients with poor clinical condition.

Abdominal Pain↗
PubMed2004

Comparison of stent placement and colostomy as palliative treatment for inoperable malignant colorectal obstruction.

BACKGROUND: Stent placement is a useful palliative treatment for inoperable acute malignant colorectal obstruction. However, data comparing stent placement with colostomy are scarce. METHODS: We compared the clinical outcome of 18 patients who had stent placement and 17 patients who underwent only colostomy. RESULTS: The postoperative hospital stay was 22.3 days for stent placement compared with 47.4 days for colostomy (p = 0.016). The duration to readmission was 129.2 days for stent placement and 188.4 days for colostomy. The estimated duration of primary stent patency was 106 days. Mean survival period was 134 days in patients with stent placement and 191 days in patients with colostomy. CONCLUSION: Postoperative hospital stay was shorter in patients with stent placement but duration to readmission and survival were longer in patients with colostomy. However, stent placement increases the option of palliative treatment and is an effective treatment contributing to improving quality of life.

Aged↗
PubMed1995

A randomized clinical trial of intraoral soft splints and palliative treatment for masticatory muscle pain.

Thirty subjects seeking treatment for masticatory muscle pain at a university-based TMJ clinic were randomly assigned to soft-splint, palliative-treatment, and no-treatment groups. After 4 to 11 weeks of treatment, subjects were evaluated for changes from their baseline levels of symptoms, maximum pain-free opening, pain thresholds measured by a pressure algometer, and occlusal contacts. With the use of the multivariate analysis of variance and analysis of covariance, the results suggest that the soft-splint group had statistically significant improvement (P < .01), the palliative-treatment group had improvement that was not statistically significant, and the no-treatment group had a slight aggravation of symptoms. The soft-splint group had fewer occlusal contact changes assessed with shimstock compared to the palliative-treatment and no-treatment groups. The findings of this study suggest that the soft splint is an effective short-term treatment for reducing the signs and symptoms of masticatory muscle pain in patients, and the soft splint does not cause occlusal changes.

Adolescent↗
PubMedDate not supplied

[Palliative treatment of cancers of the esophagus and cardia with YAG neodymium laser. (Preliminary noncontrolled trial)].

The aim of this study was to report results of endoscopic YAG laser therapy in palliative treatment of esophageal and cardial carcinoma. Twenty-eight patients were treated: 9 with adenocarcinoma and 19 with squamous cell carcinoma. Among these patients, 9 had complete aphagia; radiotherapy was contraindicated in 17; in the remaining 2 patients the aim of laser therapy was to achieve sufficient luminal enlargement to allow the endoscopic insertion of a prothesis. Dysphagia improved in 24 cases; destruction of a major portion of the intraluminal tumor was achieved in 17 patients, and incomplete destruction was possible in 9 patients. In one case, the treatment had no effect. Among 22 subjects in maintenance treatment, 13 good results were obtained. Several complications of laser therapy were observed: 2 cases of minor bleeding, 2 cases of esophagitis and 1 perforation of the upper esophagus. The patient died after surgical operation. It is concluded that endoscopic YAG laser therapy for palliative treatment of esophageal and cardial carcinoma is effective, providing rapid improvement of dysphagia. Maintenance treatment is necessary to sustain the improvement. Randomized studies are now needed to compare endoscopic laser therapy with other palliative treatment of malignant tumors of the upper gastrointestinal tract.

Adenocarcinoma↗