We prospectively evaluated the effect of antibiotic treatment on infection-related symptoms in patientswith advanced cancer, in addition to assessing infection characteristics. Methods: A questionnaire was completed for enrolled patients using a personal digital assistant. Pre-antibiotic and post-antibiotic treatment Edmonton Symptom Assessment Scale (ESAS) scores were evaluated. Patient and the patient's physician identified infection-related symptoms experienced by the patient, which were documented under the "other" category on the ESAS. Pre-antibiotic and post-antibIotic scores of the patient and physician for the identified infection-related symptoms wereevaluated. Results: Twenty-six patients on a tertiary palliative care unit with 31 episodes of infection were included for analysis. Patients' pre-and post-antibiotic ESAS scores revealed a small improvement in allvariables exceptanxiety. Patient assessment of symptoms related to infection showed a small improvement in all symptoms, with dsyuria being statistically significant. Physician assessment revealed a slight improvement for all the symptoms, although only cough was statistically significant. A general comparative physician assessment of patient outcome following antibiotic treatment suggested symptomimprovement in 48.4% of patients. However, 50% of patientsdied within a week of antibiotic discontinuation. Conclusions: Antibiotic treatment appears to offer a mild improvement in infection-related symptoms. Patients reported the greatest improvement in dysuria, and physicians, in cough. Despite this symptomatic improvement, one quarter of the patients died within one week of antibiotic administration. Further comparative studies to evaluate symptomatic benefit, patient burden, and cosVbenefit of antibiotic therapy in the treatment of infections in advanced cancerpatients arerequired.
The personalized pain goal is a feasible outcome measure for cognitively intact patients. The Edmonton Classification System for Cancer Pain definition closely resembles patient-reported personalized pain goals for stable pain and would be appropriate for research purposes. For clinical pain management, it would be important to include the personalized pain goal as standard practice.
An initial pain classification assessment, using the ECS-CP, is generally conducted prior to pain management (e.g. on admission to a palliative consultation service). Subsequent assessments may be conducted if the patient's condition changes or as additional information regarding the five pain features is obtained. The classification should be used to guide the interdisciplinary team in using different pharmacological and non-pharmacological approaches to optimize pain control. The more detailed and complete Administration manual consists of four key sections: (1) Background, (2) Edmonton Classification System for Cancer Pain, (3) Case Studies and (4) Frequently Asked Questions. Refer to that resource if you need information beyond what is provided in the Quick User Guide.
Bowel obstruction is a common complication of metastatic gastrointestinal and ovarian cancers, and can cause distressing symptoms. Along with medical options, surgical options should be considered in all patients with bowel obstruction, including percutaneous gastrostomy. We report the case of a patient with metastatic colon cancer with an obstructing recurrence at the primary site who was not eligible for major surgery or percutaneous gastrostomy and was managed with a percutaneous cecostomy for symptom control.
Abdominal pain is a frequent complaint heard in medical practice. For palliative care patients, there are numerous causes of abdominal pain. Because of the non-invasive nature of palliative care practice, emphasis is made on minimal investigations. We present a case of a 49-year old patient who developed progressive abdominal pain and was found to have gangrenous appendicitis. The patient underwent surgery and was able to be discharged home. Our findings suggest that any new pain in a cancer patient must be carefully evaluated. Because of the presence of opioid analgesics and corticosteroids, symptoms can be less severe and related to diagnosis in palliative care patients.
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