Palliative and Supportive Care

For the patient with advanced pancreatic cancer, curative strategies may not be appropriate, and palliative symptom management may be the best approach to patient care. Oncologists,

In their article, von Gunten et al lucidly define palliative care and analyze the status of this discipline within the current American health-care delivery system. They make a series of excellent points, a few of which deserve emphasis and clarification:

The authors provide a timely review of the components of hospice/palliative care programs and an informative historical perspective on the development of these programs overseas and in the United States. They also review the current mechanisms that fund hospice care and explain how the skills for delivering hospice/palliative care have been incorporated into oncology education at Northwestern University. This articles highlights the many positive aspects of hospice programs, which currently provide expert multidisciplinary care by committed and knowledgeable professionals to almost 30% of patients with cancer in this country. However, the discussion should serve to focus attention on several additional aspects of the symptomatic care of patients with cancer.

With the renaissance of interest in how best to care for patients with terminal illness comes the need to recognize palliative care and hospice programs as the completion of comprehensive cancer care, not as its antithesis. In

The appearance of metastases is generally thought to herald widespread dissemination of a primary cancer. At this point, surgery usually is either not indicated or palliative. Thus, it is somewhat surprising that surgical resection of metastases has become an accepted treatment modality in several clinical situations. This is due, in part, to the unique biology of several types of cancers and to well-defined clinical presentations that can be identified. Drs. Dresler and Goldberg succinctly review the indications for and results of resection of pulmonary metastases.

Drs. Finlayson and Eisenberg provide a timely, in-depth review of total pelvic exenteration in the palliation of incurable pelvic cancer. The authors conclude that total pelvic exenteration has a role as a palliative treatment for patients with recurrent pelvic cancer-a conclusion that I believe remains unproven.

In the past, the mere mention that a patient with persistent or recurrent pelvic cancer might benefit from a palliative pelvic exenteration was met with vigorous opposition. This was due, in part, to the fact that the term "palliative pelvic exenteration" was new and not clearly defined. There was also concern that the mortality, morbidity, and overall cost previously associated with pelvic exenterative procedures were out of keeping with the concept of palliation for cancer. However, much experience with pelvic exenterative surgery has been gained during the past 40 years, and the mortality, morbidity, length of stay, and overall cost of the procedure have decreased significantly. This has made the concept of pelvic exenteration for palliation reconcilable in carefully selected patients in the 1990s.

The authors provide an excellent overview of the role of pelvic exenteration performed as a curative cancer operation or for palliation. They extend the customary definition of palliation, however, to include exenteration intended for cure when tumor is knowingly left behind or is discovered by pathologic review of the operative specimen. The added definitions are apparently based on observations indicating that these procedures can relieve or reduce symptoms related to the disease or its treatment in some patients, resulting in an improved "quality of life," and that some patients also enjoy an extended survival after exenteration

Total pelvic exenteration is a radical abdominoperineal operation designed to treat locally extensive pelvic malignancy. In the past, the morbidity and mortality has been such that this procedure was considered justified

Cancer is a devastating, life-altering disease. As our technology and knowledge base for the treatment of carcinomas expand, however, more and more patients' lives are being spared or prolonged. Unfortunately, the quality of life for many of these

Xerostomia, or dry mouth, is a common complaint that may be caused by several conditions, which include side effects of a wide variety of drugs, such as antidepressants, therapeutic radiation to the head and neck,

Two hundred sixty-five patients with head and neck cancer who had previously participated in either a fixed-dose, dose-titration, or dose-ranging trial of oral pilocarpine hydrochloride tablets were enrolled in a 36-month

Xerostomia during and following a course of head and neck irradiation profoundly impacts the quality of life of many patients. Xerostomia not only affects mucous membranes and teeth but also interferes with patient comfort,

WASHINGTON--The FDA has approved QLT PhotoTherapeutics' light-activated drug Photofrin (porfimer sodium) for the palliative treatment of esophageal constriction in patients with advanced esophageal cancer.

WILMINGTON, Del--Zeneca Pharmaceuticals has received clearance from the FDA to market a new formulation of Zoladex (goserelin acetate implant) for the palliative treatment of advanced prostate cancer.

CHICAGO--Over the last decade, increasing attention has been paid to the palliative care of patients whose colon cancer has not responded to curative treatment so that they may achieve the best possible quality of life.

COLUMBUS, Ohio--Roxane Laboratories and the Roxane Pain Institute have announced two new scholarship programs for health-care professionals in palliative care medicine for cancer and AIDS.

This publication is the fourth in a series of quality of life symposia proceedings. The title of our first symposium, which took place in 1989, was "Quality of Life in Current Oncology Practice and Research." In the foreword to the first proceedings, we

Anderson and colleagues present a comprehensive and factually accurate overview of systemic treatment for advanced melanoma. They correctly identify dacarbazine as the only single agent officially sanctioned for the treatment of metastatic melanoma. They further opine that "dacarbazine alone remains the standard of care for initial chemotherapy treatment of metastatic melanoma." With overall response rates of 10% to 20%, a complete response rate of less than 4%, and no evidence that treatment with dacarbazine improves survival over best palliative care, one questions whether or not dacarbazine would merit approval if reevaluated today.

Hormonal manipulation is currently the mainstay of palliative care for metastatic breast cancer because it is well tolerated and produces significant responses in approximately one-third of unselected patients. Tamoxifen, a nonsteroidal antiestrogen, is currently considered first-line therapy. Second-line agents include progestins and aromatase inhibitors.

The first description of percutaneous biliary drainage in the United States appeared in 1965 [1]. The percutaneously placed catheters were left in the obstructed biliary tract for drainage for up to 5 days. Since then, biliary drainage techniques have advanced substantially, and options have proliferated. Now, the nonsurgical palliation of malignant biliary obstruction, accomplished either endoscopically or percutaneously, is a well-established therapeutic modality.

There has been a significant accumulation of collective experience with percutaneous biliary drainage (PCD) during the past 20 years. As experience with the technique has increased, its role has undergone a series of redefinitions, although early enthusiasm for percutaneous drainage has been tempered by the realities of numbers and statistics.

SAN ANTONIO--Use of docetaxel (Taxotere) as palliative treatment of advanced breast cancer produced durable responses in almost 70% of patients, including three fourths of those with liver metastases, French researchers said at a

PARIS-Physicians need to make a more concerted effort to consider quality of life issues when devising a management strategy for patients with HIV-infection, an infectious diseases specialist said at a conference on cancer, AIDS, and quality of life, sponsored by UNESCO.