Pub Date : 2018-10-03DOI: 10.1080/23809000.2018.1524708
S. Booth, Chloe Chin, A. Spathis, M. Maddocks, J. Yorke, J. Burkin, Catherine Moffat, M. Farquhar, C. Bausewein
ABSTRACTIntroduction: Breathlessness is a common and distressing symptom in people with advanced cancer of all etiologies, often co-existing with cough and fatigue. Its incidence and severity incre...
{"title":"Non-pharmacological interventions for breathlessness in people with cancer","authors":"S. Booth, Chloe Chin, A. Spathis, M. Maddocks, J. Yorke, J. Burkin, Catherine Moffat, M. Farquhar, C. Bausewein","doi":"10.1080/23809000.2018.1524708","DOIUrl":"https://doi.org/10.1080/23809000.2018.1524708","url":null,"abstract":"ABSTRACTIntroduction: Breathlessness is a common and distressing symptom in people with advanced cancer of all etiologies, often co-existing with cough and fatigue. Its incidence and severity incre...","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1524708","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46341873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-10DOI: 10.1080/23809000.2018.1519371
Crystal L. Park, Lauren M. Carney
{"title":"The supportive roles of spirituality and mindfulness in patients’ cancer journeys","authors":"Crystal L. Park, Lauren M. Carney","doi":"10.1080/23809000.2018.1519371","DOIUrl":"https://doi.org/10.1080/23809000.2018.1519371","url":null,"abstract":"","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1519371","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47177746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-04DOI: 10.1080/23809000.2018.1503539
V. Ehrbar, C. Urech, S. Tschudin
ABSTRACT Introduction: With long-term cancer survivor rates increasing, quality of life, and a pivotal component of it, the ability to procreate are of growing importance. As treatment can compromise fertility, patients need to be informed about the currently available options to preserve it. However, decisional conflict may arise, as decisions have to be made within the short time frame after diagnosis and before treatment. Areas covered: Decisional conflict reflects the personal perception of uncertainty in choosing between different options. It is typical in decision-making in the context of fertility preservation (FP). It comprises factors such as feeling uninformed, lack of clarity regarding personal values, lack of support, and uncertainty and is associated with decisional regret. Research has shown that additional support tools such as decision aids have the potential to increase knowledge and reduce decisional conflict. Expert commentary: Improvement in the availability of and access to adequate and personalized support for all young cancer patients concerning FP is needed. Information provision should be comprehensive and tailored to individual needs and ideally complemented with a decision aid. Future research should focus on more individualized decision aids and on the male perspective, as existing decision aids are targeted at female cancer patients.
{"title":"Fertility decision-making in cancer patients – current status and future directions","authors":"V. Ehrbar, C. Urech, S. Tschudin","doi":"10.1080/23809000.2018.1503539","DOIUrl":"https://doi.org/10.1080/23809000.2018.1503539","url":null,"abstract":"ABSTRACT Introduction: With long-term cancer survivor rates increasing, quality of life, and a pivotal component of it, the ability to procreate are of growing importance. As treatment can compromise fertility, patients need to be informed about the currently available options to preserve it. However, decisional conflict may arise, as decisions have to be made within the short time frame after diagnosis and before treatment. Areas covered: Decisional conflict reflects the personal perception of uncertainty in choosing between different options. It is typical in decision-making in the context of fertility preservation (FP). It comprises factors such as feeling uninformed, lack of clarity regarding personal values, lack of support, and uncertainty and is associated with decisional regret. Research has shown that additional support tools such as decision aids have the potential to increase knowledge and reduce decisional conflict. Expert commentary: Improvement in the availability of and access to adequate and personalized support for all young cancer patients concerning FP is needed. Information provision should be comprehensive and tailored to individual needs and ideally complemented with a decision aid. Future research should focus on more individualized decision aids and on the male perspective, as existing decision aids are targeted at female cancer patients.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"3 1","pages":"113 - 119"},"PeriodicalIF":0.0,"publicationDate":"2018-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1503539","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47891814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-04DOI: 10.1080/23809000.2018.1495561
Y. Razvi, Stephanie Chan, Pearl Zaki, E. McKenzie, H. Lam, J. M. van der Velden, A. AlQaderi, Maurício F. Silva, E. Chow
ABSTRACT Introduction: Clinician predicted survival (CPS) is a crucial part of palliative care but is often found to be inaccurate with most clinicians providing overestimates of survival, potentially leading to suboptimal care. The present paper reviews the literature on CPS in patients receiving palliative radiotherapy and assesses the accuracy of clinician generated survival estimates. Method: A search of Cochrane Central Register of Controlled Trials, Embase, and Ovid MEDLINE was conducted on 2 February 2018 to identify English articles analyzing the accuracy of CPS in cancer patients receiving palliative radiotherapy. Results: Seven studies were included in this review. Survival was overestimated on average, with overestimates ranging from +22.8 to +167.3 days. One study reported average underestimates of survival. No significant differences in accuracy were seen between disciplines. There was no correlation between years of experience and accuracy of CPS. Expert commentary: The incorporation of accurate CPS into treatment and family-related decisions can improve quality of life of palliative radiotherapy patients. Research is needed on survival estimates informed by prognostic tools, validation of prognostic tools specific to palliative settings, and the effects of CPS on dose fractionation and other treatment decisions.
摘要简介：临床医生预测生存率（CPS）是姑息治疗的重要组成部分，但通常被发现是不准确的，因为大多数临床医生高估了生存率，可能导致次优护理。本文综述了接受姑息性放射治疗的患者的CPS文献，并评估了临床医生生成的生存估计的准确性。方法：2018年2月2日检索Cochrane Central Register of Controlled Trials、Embase和Ovid MEDLINE，以确定分析CPS在接受姑息性放疗的癌症患者中准确性的英文文章。结果：本综述包括7项研究。平均而言，生存期被高估，高估范围从+22.8天到+167.3天。一项研究报告了对生存率的平均低估。不同学科之间的准确性没有显著差异。多年的经验与CPS的准确性之间没有相关性。专家评论：将准确的CPS纳入治疗和家庭相关决策可以提高姑息性放疗患者的生活质量。需要研究预后工具提供的生存率估计、针对姑息治疗环境的预后工具的验证，以及CPS对剂量分割和其他治疗决策的影响。
{"title":"Predicting survival of patients treated with palliative radiotherapy: a systematic review","authors":"Y. Razvi, Stephanie Chan, Pearl Zaki, E. McKenzie, H. Lam, J. M. van der Velden, A. AlQaderi, Maurício F. Silva, E. Chow","doi":"10.1080/23809000.2018.1495561","DOIUrl":"https://doi.org/10.1080/23809000.2018.1495561","url":null,"abstract":"ABSTRACT Introduction: Clinician predicted survival (CPS) is a crucial part of palliative care but is often found to be inaccurate with most clinicians providing overestimates of survival, potentially leading to suboptimal care. The present paper reviews the literature on CPS in patients receiving palliative radiotherapy and assesses the accuracy of clinician generated survival estimates. Method: A search of Cochrane Central Register of Controlled Trials, Embase, and Ovid MEDLINE was conducted on 2 February 2018 to identify English articles analyzing the accuracy of CPS in cancer patients receiving palliative radiotherapy. Results: Seven studies were included in this review. Survival was overestimated on average, with overestimates ranging from +22.8 to +167.3 days. One study reported average underestimates of survival. No significant differences in accuracy were seen between disciplines. There was no correlation between years of experience and accuracy of CPS. Expert commentary: The incorporation of accurate CPS into treatment and family-related decisions can improve quality of life of palliative radiotherapy patients. Research is needed on survival estimates informed by prognostic tools, validation of prognostic tools specific to palliative settings, and the effects of CPS on dose fractionation and other treatment decisions.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"3 1","pages":"105 - 111"},"PeriodicalIF":0.0,"publicationDate":"2018-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1495561","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49602426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-04DOI: 10.1080/23809000.2018.1503538
L. Soares-Miranda, S. Abreu, A. Ruiz-Casado, A. Lucia
ABSTRACT Introduction: Once often perceived as a death sentence, colorectal cancer (CRC) is now a frequently treatable illness for most and a chronic disease for many. The number of people living with a diagnosis of CRC is expected to rise. Even after successful treatment, CRC survivors, mostly the elderly, frequently experience health problems and impaired quality of life (QoL). Areas covered: We present a review on the effects of physical activity and/or nutritional interventions in the QoL of CRC survivors as well as an explanatory introduction to the topic. Expert commentary: Targeting unhealthy lifestyle behavior of these vulnerable individuals during post-treatment care is a promising strategy for improving their health status and QoL, but more evidence is needed, especially for QoL. Thus, besides survival, efforts should also be directed toward improving the QoL of CRC survivors.
{"title":"Physical activity and nutritional interventions and health-related quality of life in colorectal cancer survivors: a review","authors":"L. Soares-Miranda, S. Abreu, A. Ruiz-Casado, A. Lucia","doi":"10.1080/23809000.2018.1503538","DOIUrl":"https://doi.org/10.1080/23809000.2018.1503538","url":null,"abstract":"ABSTRACT Introduction: Once often perceived as a death sentence, colorectal cancer (CRC) is now a frequently treatable illness for most and a chronic disease for many. The number of people living with a diagnosis of CRC is expected to rise. Even after successful treatment, CRC survivors, mostly the elderly, frequently experience health problems and impaired quality of life (QoL). Areas covered: We present a review on the effects of physical activity and/or nutritional interventions in the QoL of CRC survivors as well as an explanatory introduction to the topic. Expert commentary: Targeting unhealthy lifestyle behavior of these vulnerable individuals during post-treatment care is a promising strategy for improving their health status and QoL, but more evidence is needed, especially for QoL. Thus, besides survival, efforts should also be directed toward improving the QoL of CRC survivors.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"3 1","pages":"104 - 95"},"PeriodicalIF":0.0,"publicationDate":"2018-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1503538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42856079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-04DOI: 10.1080/23809000.2018.1483192
R. Lehto, Sara E. Miller, M. Flanigan, G. Wyatt
ABSTRACT Introduction: The mental health of patients with advanced cancer at the end of life is a strong contributor to suffering on the part of both the patient and family. A closer look is needed to address the complexity of psychological adaptation to provide a comfortable transition between life and death. Areas covered: This review describes patient related factors, interventions, and outcomes targeting maintaining and improving mental health for individuals with advanced cancer at the end of life. The Preferred Reporting Items for Systematic reviews and Meta-analyses was used to review the state of the science and the evidence-based hierarchy provided a structure for ranking research quality. Expert commentary: Psychological adaptation for patients with advanced cancer is often comingled with physical symptoms to the extent that neither is distinct. Quality of life is essential in comfort care at end of life. All contributing factors must be considered including the often-missed spiritual needs, cultural factors, developmental issues, and communication relative to end of life. Discussed are both gaps in the science and interventions useful to enhancement of mental health comfort for patients with advanced cancer and their families at the end of life.
{"title":"Mental health in patients with advanced cancer at the end of life: evaluation of evidence and future directions","authors":"R. Lehto, Sara E. Miller, M. Flanigan, G. Wyatt","doi":"10.1080/23809000.2018.1483192","DOIUrl":"https://doi.org/10.1080/23809000.2018.1483192","url":null,"abstract":"ABSTRACT Introduction: The mental health of patients with advanced cancer at the end of life is a strong contributor to suffering on the part of both the patient and family. A closer look is needed to address the complexity of psychological adaptation to provide a comfortable transition between life and death. Areas covered: This review describes patient related factors, interventions, and outcomes targeting maintaining and improving mental health for individuals with advanced cancer at the end of life. The Preferred Reporting Items for Systematic reviews and Meta-analyses was used to review the state of the science and the evidence-based hierarchy provided a structure for ranking research quality. Expert commentary: Psychological adaptation for patients with advanced cancer is often comingled with physical symptoms to the extent that neither is distinct. Quality of life is essential in comfort care at end of life. All contributing factors must be considered including the often-missed spiritual needs, cultural factors, developmental issues, and communication relative to end of life. Discussed are both gaps in the science and interventions useful to enhancement of mental health comfort for patients with advanced cancer and their families at the end of life.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"3 1","pages":"73 - 94"},"PeriodicalIF":0.0,"publicationDate":"2018-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1483192","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44610533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-04DOI: 10.1080/23809000.2018.1472524
A. Retzer, D. Kyte, L. Calman, A. Glaser, R. Stephens, M. Calvert
ABSTRACT Introduction: Cancer incidence is increasing; one in two people in the UK are expected to develop cancer during their lifetime. However, survival rates of people living with cancer have improved over the last few decades. More than 50% of all UK cancer patients survive for beyond 10 years, this rate has doubled in the last 40 years. Areas covered: This article provides a scientific review of the use of patient reported outcomes (PROs) to assess the short and longer term impact of cancer and treatment on patient quality of life and symptoms. Expert commentary: There is increasing recognition that, in addition to survival and other clinical metrics, we need to understand more about the impact that cancer and its treatment has on the everyday lives of people living with and beyond cancer. Patients must have access to information around quality of life and survival with which they can make more informed decisions about their care. We need to understand more about the natural history of recovery and wellbeing and the contributory factors to identify those who are not doing well and to understand how we can support them better, plan appropriate services and support patients in making choices about treatment.
{"title":"The importance of patient-reported outcomes in cancer studies","authors":"A. Retzer, D. Kyte, L. Calman, A. Glaser, R. Stephens, M. Calvert","doi":"10.1080/23809000.2018.1472524","DOIUrl":"https://doi.org/10.1080/23809000.2018.1472524","url":null,"abstract":"ABSTRACT Introduction: Cancer incidence is increasing; one in two people in the UK are expected to develop cancer during their lifetime. However, survival rates of people living with cancer have improved over the last few decades. More than 50% of all UK cancer patients survive for beyond 10 years, this rate has doubled in the last 40 years. Areas covered: This article provides a scientific review of the use of patient reported outcomes (PROs) to assess the short and longer term impact of cancer and treatment on patient quality of life and symptoms. Expert commentary: There is increasing recognition that, in addition to survival and other clinical metrics, we need to understand more about the impact that cancer and its treatment has on the everyday lives of people living with and beyond cancer. Patients must have access to information around quality of life and survival with which they can make more informed decisions about their care. We need to understand more about the natural history of recovery and wellbeing and the contributory factors to identify those who are not doing well and to understand how we can support them better, plan appropriate services and support patients in making choices about treatment.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"3 1","pages":"65 - 71"},"PeriodicalIF":0.0,"publicationDate":"2018-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1472524","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47972117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-26DOI: 10.1080/23809000.2018.1467211
P. Lawlor, Niamh Lawlor, P. Reis-Pina
ABSTRACT Introduction: Undertreatment of cancer pain is associated with inadequate assessment and inconsistent or non-standardized classification, resulting in failure to both appreciate its multidimensional nature and appropriately target therapeutic interventions. This review examines the classification of cancer pain with a focus on the progressive development of the Edmonton Classification System for Cancer Pain (ECS-CP); the appropriateness of its constituent features, associated outcomes and its potential future development in cancer pain classification. Areas covered: A Medline search from 1989 to November 2017, using combined terms ‘cancer’ or ‘oncology’, ‘Edmonton’, ‘pain’ or ‘analgesia’, and ‘staging’ or ‘classification’, identified 280 records. A total of 20 studies with empirical data relating to validation studies of the ECS-CP or evaluation of either its constituent or proposed domains were selected for inclusion in the core review. Expert commentary: The ECS-CP is a tool in evolution and a valid template for further cancer pain classification development. The assessment of ECS-CP domains requires a standardized approach. The domain ratings can inform the therapeutic strategy, and are associated with pain management outcomes, particularly stable pain control. The ECS-CP enables standardized reporting, based on patients’ pain and related characteristics, and thus may improve the validity of comparisons across research study samples.
{"title":"The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management","authors":"P. Lawlor, Niamh Lawlor, P. Reis-Pina","doi":"10.1080/23809000.2018.1467211","DOIUrl":"https://doi.org/10.1080/23809000.2018.1467211","url":null,"abstract":"ABSTRACT Introduction: Undertreatment of cancer pain is associated with inadequate assessment and inconsistent or non-standardized classification, resulting in failure to both appreciate its multidimensional nature and appropriately target therapeutic interventions. This review examines the classification of cancer pain with a focus on the progressive development of the Edmonton Classification System for Cancer Pain (ECS-CP); the appropriateness of its constituent features, associated outcomes and its potential future development in cancer pain classification. Areas covered: A Medline search from 1989 to November 2017, using combined terms ‘cancer’ or ‘oncology’, ‘Edmonton’, ‘pain’ or ‘analgesia’, and ‘staging’ or ‘classification’, identified 280 records. A total of 20 studies with empirical data relating to validation studies of the ECS-CP or evaluation of either its constituent or proposed domains were selected for inclusion in the core review. Expert commentary: The ECS-CP is a tool in evolution and a valid template for further cancer pain classification development. The assessment of ECS-CP domains requires a standardized approach. The domain ratings can inform the therapeutic strategy, and are associated with pain management outcomes, particularly stable pain control. The ECS-CP enables standardized reporting, based on patients’ pain and related characteristics, and thus may improve the validity of comparisons across research study samples.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"3 1","pages":"47 - 64"},"PeriodicalIF":0.0,"publicationDate":"2018-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1467211","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47438014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-02DOI: 10.1080/23809000.2018.1438845
K. Joseph, H. Warkentin, K. Mulder, C. Doll
ABSTRACT Introduction: Hematological toxicity (HT) remains a major side effect of anal cancer (AC) treatment that can lead to unplanned treatment breaks and may affect clinical outcome. Areas covered: This review paper analyses the predictive factors related to HT and methods to minimize HT. Expert commentary: The destruction of red bone marrow (BM) stem cells are responsible for acute HT. BM damage is correlated with radiation dose and volume of BM irradiated. Functional imaging has been used to precisely quantify specific regions of active Pelvic BM . Studies using LKB modelling confirmed that PBM and LSBM act like parallel organs with a consistent volume effect in the development of HT. BM dose-volume constraints are recommended to minimise HT. BM-sparing IMRT plans incorporating active BM sites as avoidance structures resulted in significant reduction of dose to PBM without compromising target coverage and decreased the dose delivered to the functional BM volume. The increased incidence of HT is attributed more to MMC rather than IMRT. A single dose of MMC could be considered to minimize the incidence of HT. Clinical research should focus on newer more potent and potentially less toxic systemic agents to be used in combination with radiation.
{"title":"Minimizing hematological toxicity in the management of anal cancer patients","authors":"K. Joseph, H. Warkentin, K. Mulder, C. Doll","doi":"10.1080/23809000.2018.1438845","DOIUrl":"https://doi.org/10.1080/23809000.2018.1438845","url":null,"abstract":"ABSTRACT Introduction: Hematological toxicity (HT) remains a major side effect of anal cancer (AC) treatment that can lead to unplanned treatment breaks and may affect clinical outcome. Areas covered: This review paper analyses the predictive factors related to HT and methods to minimize HT. Expert commentary: The destruction of red bone marrow (BM) stem cells are responsible for acute HT. BM damage is correlated with radiation dose and volume of BM irradiated. Functional imaging has been used to precisely quantify specific regions of active Pelvic BM . Studies using LKB modelling confirmed that PBM and LSBM act like parallel organs with a consistent volume effect in the development of HT. BM dose-volume constraints are recommended to minimise HT. BM-sparing IMRT plans incorporating active BM sites as avoidance structures resulted in significant reduction of dose to PBM without compromising target coverage and decreased the dose delivered to the functional BM volume. The increased incidence of HT is attributed more to MMC rather than IMRT. A single dose of MMC could be considered to minimize the incidence of HT. Clinical research should focus on newer more potent and potentially less toxic systemic agents to be used in combination with radiation.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"3 1","pages":"27 - 33"},"PeriodicalIF":0.0,"publicationDate":"2018-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1438845","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42420727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-02DOI: 10.1080/23809000.2018.1425994
M. Salvini, Giusy Cetani
ABSTRACT Introduction: Pain afflicts quality of life and is common in cancer patients. Multiple myeloma is a hematological malignancy often associated with pain. In the last two decades overall survival improved thanks to introduction of novel chemotherapeutic agents such as the proteasome inhibitor bortezomib, and the immunomodulatory drug thalidomide. Unfortunately, these agents could be responsible for development of painful peripheral neuropathy. Areas covered: This review describes strategies for prevention and treatment of pain in multiple myeloma, focusing especially on bone lesions and neuropathy, considered as the main causes of pain in the disease. Expert commentary: Management of pain in multiple myeloma requires a multidisciplinary clinical assessment and a careful follow-up to offer the best treatment, best matched to each patient. Mild to moderate pain could be treated with paracetamol and/or weak opioids, while severe pain requires stronger analgesics. Bisphosphonates, kyphoplasty, vertebroplasty, and radiotherapy are specifically indicated for bone involvement. Neuropathy could be treated removing the cause and controlling symptoms. If it is drug-related, appropriate dose modification/suspension is mandatory. Further studies are needed to better understand pain etiopathogenesis, allowing elaboration of more efficacious analgesic strategies, especially for neuropathic and chronic pain management in order to improve quality of life in cancer patients.
{"title":"Pain management in multiple myeloma","authors":"M. Salvini, Giusy Cetani","doi":"10.1080/23809000.2018.1425994","DOIUrl":"https://doi.org/10.1080/23809000.2018.1425994","url":null,"abstract":"ABSTRACT Introduction: Pain afflicts quality of life and is common in cancer patients. Multiple myeloma is a hematological malignancy often associated with pain. In the last two decades overall survival improved thanks to introduction of novel chemotherapeutic agents such as the proteasome inhibitor bortezomib, and the immunomodulatory drug thalidomide. Unfortunately, these agents could be responsible for development of painful peripheral neuropathy. Areas covered: This review describes strategies for prevention and treatment of pain in multiple myeloma, focusing especially on bone lesions and neuropathy, considered as the main causes of pain in the disease. Expert commentary: Management of pain in multiple myeloma requires a multidisciplinary clinical assessment and a careful follow-up to offer the best treatment, best matched to each patient. Mild to moderate pain could be treated with paracetamol and/or weak opioids, while severe pain requires stronger analgesics. Bisphosphonates, kyphoplasty, vertebroplasty, and radiotherapy are specifically indicated for bone involvement. Neuropathy could be treated removing the cause and controlling symptoms. If it is drug-related, appropriate dose modification/suspension is mandatory. Further studies are needed to better understand pain etiopathogenesis, allowing elaboration of more efficacious analgesic strategies, especially for neuropathic and chronic pain management in order to improve quality of life in cancer patients.","PeriodicalId":91681,"journal":{"name":"Expert review of quality of life in cancer care","volume":"3 1","pages":"18 - 9"},"PeriodicalIF":0.0,"publicationDate":"2018-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23809000.2018.1425994","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41574971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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