Pain increased after radical cystectomy and remained increased 6 months postoperatively. There was a trend toward increased posttraumatic growth at 2 months. Otherwise, by 6 months cystectomy was associated with no improvement in preoperative symptoms of fatigue, quality of life, spiritual well-being, depression or anxiety. After cystectomy pain should be assessed and treated more aggressively in patients with bladder cancer and efforts should be made to improve postoperative symptoms.
Anorexia is defined as an involuntary loss of appetite.Approximately 50% of newly diagnosed patients with cancer experience the symptom, which often is accompanied by weight loss and most typically associated with advanced disease.Anorexia significantly affects the clinical course of cancer; it can lead to the development or exacerbation of disease- or treatment-related symptoms, decreased functional status, and diminished quality of life.As part of the Oncology Nursing Society's Putting Evidence Into Practice initiative, a team of oncology nurses examined and evaluated published research literature for the purpose of developing an evidence-based practice resource focused on the management of cancer-related anorexia.Even though anorexia is common among newly diagnosed patients and those with advanced disease, interventions to prevent, treat, and manage the symptom are limited.The evidence revealed that only two pharmacologic interventions, corticosteroids and progestins, can be recommended for use in clinical practice, and dietary counseling was identified as likely to be effective.This article summarizes selected empirical literature on interventions used to prevent and manage anorexia in patients with cancer.Familiarity with the literature will assist oncology nurses in proactively identifying and effectively managing patients experiencing this distressing symptom.
11 Background: To characterize the impact of palliative care concurrent with usual urologic care for bladder cancer patients undergoing cystectomy. Methods: Prospective, 6 month, serial cohort study comparing 33 participants receiving usual care with cystectomy for muscle invasive bladder cancer with 30 participants also receiving concurrent palliative care. Patients and family caregivers completed validated symptom assessment and satisfaction surveys pre-operatively and two, four, and six months post-operatively. Results: The intervention group saw improvements in most symptom measures over the six months following cystectomy compared to the control group. Depression and anxiety decreased over the six-month period for intervention patients, but increased over this time among controls (p=0.01). Fatigue fell to a minimum for intervention group participants at four months, while it peaked at this time for control participants (0.002). Quality of life and post-traumatic growth scores followed a similar pattern, with scores peaking at four months for the intervention group while controls reported their lowest scores at this time (p=0.01 and p=0.03, respectively). Changes in pain scores did not reach statistical significance. Neither family caregiver burden nor patient satisfaction showed statistically significant changes over time. Conclusions: Patients who received concurrent palliative care in addition to usual urologic care following radical cystectomy for muscle-invasive bladder had better outcomes, including improved fatigue, depression, quality of life, and post-traumatic growth. While further research on this topic is needed, our results suggest that providing palliative care services in addition to usual urologic care for bladder cancer patients may significantly reduce post-operative symptoms.
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