Hope, hopelessness and fatigue are important experiences for patients and family members in palliative care. The aim of the study was to describe the level of and relation between hope, hopelessnes ...

The level of and relation between hope, hopelessness and fatigue in patients and family members in palliative care

Guidelines for a Palliative Approach in Residential Aged Care

Purpose Consumer perceptions are important measures of the quality of cancer care This article describes the validation of new measures of the quality of cancer care at the time of diagnosis and treatment for advanced cancer with life-limiting prognosis Methods Focus groups, review of guidelines, and an expert panel were used to construct two surveys of the quality of cancer care A prospective cohort study examined the reliability and validity of three problem scores (ie, counts of the opportunities to improve the quality of care) that examine care at the time of diagnosis and initial treatment Results At the first interview, 58% of 206 cancer patients (549% females; 275% with lung cancer; 54% with pancreatic cancer; 304% with colorectal cancer; 186% with breast cancer; mean age, 666 years) identified one or more concerns with communication about being diagnosed with advanced cancer At the second interview, 570% of the respondents voiced one or more concerns about treatment communication, and 

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Cancer Patient Assessment and Reports of Excellence: Reliability and Validity of Advanced Cancer Patient Perceptions of the Quality of Care

Fatigue and its risk factors in cancer patients who seek emergency care.

Hospitalized cancer patients undergoing intensive or high-dose chemotherapy often experience a considerable decline in functional performance associated with the increased risk of adverse health events. Exercises, particularly resistance-based exercises that may counteract this decline are restricted by therapy-related side effects. Since whole body vibration (WBV) is known to efficiently stimulate the neuromuscular system without significantly raising blood pressure, we hypothesize that especially WBV is particularly feasible even during intensive or high-dose chemotherapy (primary endpoint) and thus induces beneficial functional adaptations. Twenty hospitalized patients with hematological malignancies scheduled for intensive or high-dose chemotherapy were randomly allocated to an intervention group (IG) undergoing WBV, or an active control group (CG) cycling. Feasibility was determined by comparing the IG’s and CG’s training compliance. Furthermore, to assess feasibility, WBV-induced changes in chemotherapy-related side effects, blood pressure, and heart rate immediately after exercising were documented. To assess patients’ functional performance, we measured jump height (cm), the duration (sec) of performing the chair rising- (CRT) and timed-up-and-go test (TUG), maximum power output during jumping and CRT (watt/kg) as well as sway path (mm) during balance tasks. Training compliance was similar between groups (IG: median 62%, range 39–77; CG: 67%, 58–100; p = 0.315). Moreover, we observed neither the IG’s reported side effects worsening, nor any increase in blood pressure after WBV. IG’s jump height (+ 2.3 cm, 95%CI 0.1–4.4, p = 0.028) and TUG performance (− 1.3 s, 95%CI -2.53 – -0.65, p = 0.027) improved significantly, while sway paths in semi-tandem stance were augmented after the intervention (eyes open: + 60 mm, 95%CI 2–236, p = 0.046; eyes closed: + 88 mm, 95%CI 49–214, p = 0.028). The CG’s performances did not change over time. Maximum power output during CMJ and CRT and time during CRT did not change. Our study is the first proving the feasibility of WBV during intensive/high-dose chemotherapy of hospitalized cancer patients. Additionally, WBV-induced neuromuscular adaptations resulted in functional benefits relevant to patients’ autonomy. We believe that WBV can be implemented as an alternative training method during intensive chemotherapy, although the relative benefit compared to conventional resistance training requires more evaluation in future studies. German Register of Clinical Trials No.: DRKS00004338
 , prospectively registered on 11/30/2012.

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Feasibility of whole body vibration during intensive chemotherapy in patients with hematological malignancies – a randomized controlled pilot study

Cancer-related fatigue is one of the most important untreated symptoms of cancer, with a prevalence between 60 and 100%, but there has been a reluctance to prioritize fatigue and develop effective management strategies. The development of standards and guidelines will encourage a more systematic approach and help to stimulate further research. The Mersey Palliative Care Audit Group has developed guidelines for the assessment and management of fatigue. These guidelines were produced following a regional survey, which looked at both the educational needs of nurses, and the impact of fatigue on patients with advanced cancer.

P Saltmarsh

Papers

Assessment and management of fatigue in patients with advanced cancer: developing guidelines.