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At least 19 recordsLinked to original sources
PubMedDate not supplied

[Difficulties regarding the development of palliative treatment].

Palliative care is the branch of medicine which studies and applies the best way to cure when the traditional method is no longer able to interrupt the course of the disease until death. Two of the main characteristics of this kind of cure is to offer a support system to help the patient's family during the illness and to involve psychological care of the patient. The different approach with the patient and the new role of the doctor are just two obstacles of the spread of the palliative cure.

Humans↗
PubMed1999

Treatment of locally advanced pancreatic carcinoma in Sweden. A health economic comparison of palliative treatment with best supportive care versus palliative treatment with gemcitabine in combination with best supportive care.

OBJECTIVE: Patients with pancreatic cancer have only short survival after diagnosis, irrespective of treatment. The aim of this study was to perform a health economic evaluation of present standard treatment (in most cases, palliative treatment in combination with best supportive care) versus palliative treatment with gemcitabine in combination with best supportive care in patients with locally advanced pancreatic carcinoma. DESIGN: The use of resources and associated costs according to present treatment practice were estimated and calculated retrospectively. Costs were calculated from diagnosis until death. Actual costs and treatment effects for the patient population were compared with expected treatment costs for the same population if they additionally received gemcitabine. SETTING: This economic analysis is based on a hypothetical comparison and was performed from a societal point of view. PATIENTS AND PARTICIPANTS: The study population consisted of all patients diagnosed with pancreatic cancer during the year April 1994 to March 1995 and resident in Stockholm County, Sweden. After exclusions, 184 patients were included in the economic analysis. INTERVENTIONS: The effects of gemcitabine treatment on survival and disease-related symptoms were extrapolated from the results of a recent randomised clinical trial in North America. MAIN OUTCOME MEASURES AND RESULTS: The estimated additional costs for chemotherapy, treatment of adverse effects and in- and outpatient care associated with gemcitabine treatment were approximately 132,000 Swedish kronor (SEK) per life-year gained. This result is comparable with costs per life-year gained for other accepted treatments, for example those of home dialysis and kidney transplants for chronic renal failure. CONCLUSIONS: Treatment with gemcitabine in patients with pancreatic cancer may be a cost-effective alternative, but the results need to be confirmed in future randomised trials.

Adult↗
PubMed1983

Endoscopic Nd:YAG laser therapy for carcinoma of the esophagus: a new form of palliative treatment.

A new palliative treatment technique for esophageal carcinoma using endoscopic neodymium:yttrium aluminum garnet (Nd:YAG) laser therapy is described in 14 patients for whom no curative therapy is possible. Tumors ranged in length from 5 to 11 cm (mean 8.2 cm) and in 11 patients luminal occlusion before treatment was greater than 90%. The mean number of treatments required to alleviate symptoms and remove obstruction was 5.3 (range 2-13) and the mean number of days required was 11.6 (range 5-28). An average of 4615 W-s were given per treatment and the mean total energy per patient was 24,394 W-s. In all 14 patients, clinical, endoscopic, and radiographic improvement was noted. Two major complications occurred which may possibly have been caused by laser therapy. The overall results are encouraging and hold promise for a patient population in whom the therapeutic options are generally very limited.

Aged↗
PubMed2001

Current options for palliative treatment in patients with pancreatic cancer.

Palliative treatment is often the only remaining option in the management of pancreatic carcinoma, but its efficacy is poor due to low tumor sensitivity and inadequate treatment protocols. There are several options of palliative treatment with antitumor or supportive intention. Classical end points of palliative treatment are survival, tumor response, and quality of life. A decade ago, palliative chemotherapy consisted mainly of 5-fluorouracil as the standard agent in combination with either other agents and/or radiotherapy. Only the new antineoplastic drug gemcitabine, which was introduced simultaneously with the definition of novel end points of chemotherapy such as clinical benefit, allowed to achieve some progress. However, while gemcitabine monotherapy appeared to be superior to 5-fluorouracil and improved important parameters of quality of life, it could not provide a significant improvement of survival. A novel concept, therefore, is to improve this beneficial cytostatic response in pancreatic carcinoma using a gemcitabine-based protocol by combining it with antineoplastic drugs such as taxanes or platin analogs. This strategy may have the potential to improve the outcome in palliative chemotherapy of pancreatic carcinoma patients with advanced tumor growth or metastases. Best supportive care in pancreatic cancer consists of the treatment of symptoms, such as pain, jaundice, duodenal obstruction, weight loss, exocrine pancreatic insufficiency, and tumor-associated depression.

Antimetabolites, Antineoplastic↗
PubMed1988

[Indications and limitations of laser treatment for early gastric cancer and palliative treatments for malignant obstruction of the esophagus and stomach].

The long-term effect of endoscopic laser treatment for early gastric cancer as a local curative procedure was reported. Forty-seven patients with endoscopically diagnosed early gastric cancer whose surgical risk was critical or who refused surgery were treated by either photocoagulative Nd: YAG laser (YAG) or photodynamic therapy (PDT) with argon dye laser and hematoporphyrin derivatives (HpD) or both and followed-up for more than 3 years. Thirty-one patients were initially treated by YAG. One patient was lost to follow-up. Sixteen of 30 cases (53%) treated by YAG were negative for cancer on biopsy for 9 to 73 months (mean 3 years and 7 months) after the initial treatment. Sixteen cases were initially treated by PDT. Eight of 14 cases (57%) treated by PDT with argon dye laser were negative for cancer on biopsy for 19 to 35 months (mean 1 year and 7 months). Ten of 13 cases treated by combined laser therapy were negative for cancer on biopsy for 12 to 77 months (mean 3 years and 2 months). Curative effect of YAG and PDT was expected in lesions of superficially elevated mucosal cancer (type) IIa less than 20mm and well demarcated superficially depressed mucosal cancer (type IIc) less than 10mm. PDT was superior to YAG in treating early gastric cancer, particularly when the margin of lesion is unclear, and depth of cancer invasion is estimated to be submucosal. Risks of lymph node metastasis in these lesions are reportedly minimal as well. Quality of life scores did not decrease when the patients were treated by lasers, but did so statistically significantly in the surgically treated group of patients. Therefore, we conclude that the endoscopic laser is the treatment of choice of treatment for early gastric cancer as a local curative procedure in the aged if they have a curable lesion as mentioned above. As a palliative treatment, 34 patients with neoplastic obstruction of the esophagus and stomach were treated by dilators with or without intubation of prosthesis tube and laser recanalization. Functional efficacy (ability to eat solid or semi-solid diet which could not be eater before treatment) was noted in 64% of 11 cases treated by dilators alone, 75% of 12 cases treated by intubation of prosthesis tube and 45% of 11 cases treated by lasers. There was a greater complication rate in the intubation group also. Patients with malignant stricture due to mediastinal lymph node metastasis were at higher risk of perforation.

Aged↗
PubMed1999

Surgical palliative treatment in bilio-pancreatic malignancy.

Most patients with bilio-pancreatic malignancy are no candidate for curative resection and will need palliative treatment. Palliation in these patients is focussed on relief symptoms such as obstructive jaundice, duodenal obstruction and pain. It has been suggested that non surgical treatment (stenting) is the optimal palliation for patients with short survival and surgical bypass for those surviving more than 6 months. Unfortunately valid criteria for estimating survival are not available except for metastases. A prognostic score chart to predict survival probabilities for 3,6 and 9 months after diagnosis has been developed. The use of this prognostic score chart may help clinicians to select optimal palliative treatment for individual patients. Surgical biliary drainage can be performed by a simple cholecystoenterostomy; a choledochoduodenostomy or a choledocho/hepaticojejunostomy with Roux-Y jejunal limb reconstruction. The present data available in the literature do not give sufficient guidance to make a well deliberated selection between the different types of bypass surgery but choledochojejunostomy is generally preferred. Gastroentero-stomy is performed routinely during the biliary bypass procedure in our institution because gastric outlet obstruction has been described between 9-21% of the patients who underwent only a surgical biliary bypass but there is still controversy. Recently it was also suggested that there is an indication to perform palliative resections. No results are available to justify resections as a debulking procedure.

Biliary Tract Neoplasms↗
PubMed1977

CEA monitoring of palliative treatment for colorectal carcinoma.

Palliative treatment was applied to 131 cases of unresectable or palliatively resected colorectal carcinoma being monitored with serial CEA determinations. There were 84 instances of disease progression with 67 (80%) of them showing an increase in CEA above pretreatment levels or maintaining high levels, and 17 (20%) showing a fall when compared to pretreatment values or maintaining low initial values. There was a clear-cut regression of the disease in only 9 instances. In all 9, the CEA clearly dropped or maintained low valles throughout the period of regression. No patient in regression had a rise or maintained an elevated CEA level. These changes in CEA followed closely the clinical response of our patient to the use of a particular agent, although for the Nitrosourea compounds there may be a tendency to lower the CEA regardless of the patient's tumor response to the drug. This could be due to the fact that the Nitrosoureas produce a diffuse block of cellular activity, both at the nucleous and cytoplasm; while other compounds act as alkylating agents or by inhibition of enzymes involved in the metabolism of nucleic acids (i.e., 5-FU inhibiting thymidylate synthetase). In general, longer survival was found in those patients who had initially lower levels of CEA as compared to those with high initial levels. The patients with a favorable CEA response to the treatment (falling CEA or maintained low value), even in many who did not show a clinical response had a longer survival than the group with rising or stable high levels. The main value in CEA monitoring of patients resides in its correlation with the amount of disease present and then its ability to detect progression of tumor mass which is not clinically measurable.

Adult↗
PubMed2006

Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas.

BACKGROUND: Life expectancy in patients with unresectable pancreatic cancer has improved by using new chemotherapeutic regimens. Biliary and digestive stenoses can be endoscopically treated in most cases. However, long-term efficacy of these stenting procedures remains unknown. AIM: To evaluate the incidence of biliary and duodenal stenoses as well as technical success and short- and long-term patency of endoscopically deployed stents in patients with unresectable pancreatic cancer. PATIENTS AND METHODS: All consecutive patients with unresectable cancer of the pancreatic head seen between January 1999 and September 2003 in our center were retrospectively studied. Patients with biliary and/or duodenal stenoses underwent endoscopic stent insertion as first intention therapy. Outcomes included technical and clinical success, stent patency, and survival. RESULTS: One hundred patients, median age 65 yr (32-85), with locally advanced (62%) or metastatic (38%) pancreatic cancer were studied. Eighty-three percent received at least one line of chemotherapy. The actuarial median survival was 11 months (0.7-29.3). Biliary and duodenal stenoses occurred in 81 and 25 patients, respectively. A biliary stent was successfully placed in 74 patients (91%). When a self-expandable metallic stent was first introduced (N = 59), a single stent was sufficient in 41 patients (69%) (median duration of stent patency 7 months (0.4-21.1)). Duodenal stenting was successful in 24 patients (96%); among them, 96% required a single stent (median duration of stent patency 6 months [0.5-15.7]). In the 23 patients who developed both biliary and duodenal stenoses, combined stenting was successful in 91% of cases. No major complication or death occurred related to endoscopic treatment. CONCLUSION: Endoscopic palliative treatment of both biliary and duodenal stenoses is safe and effective in the long term, including in patients with combined obstructions. Use of such palliative management is justified as repeat procedures are rarely required even in patients who have a long survival.

Adenocarcinoma↗
PubMedDate not supplied

[Palliative treatment in neoplastic jaundice. Personal experience].

The palliative treatment of biliary duct neoplastic obstruction represents a problem of great importance and frequently can't leave out of consideration patients clinical conditions and phase of neoplastic disease. Authors, in this article refers their experience on palliative treatment of neoplastic jaundice and indications for surgical or endoscopic treatment. Their experience shows that surgical palliation must be performed in patients with preoperative instrumental investigations without "surgical risk", this vouches for a better quality of life than endoscopic procedure performed with diffuse neoplastic disease and in patients with surgical risk.

Aged↗
PubMed1985

[Palliative treatment for unresectable cases of pancreatic carcinoma].

Palliative treatment have been performed in 50 cases of unresectable pancreatic carcinoma during these nine years. There were 36 in the head and 14 in the body and tail on the location of the tumor. Operation was performed in 35 cases (70%) and about 60% of which were diagnosed as unresectable for liver metastases. Prophylactic gastroenterostomy concomitant with biliary bypass is considered to be the most suitable procedure and should be performed routinely regardless of duodenal obstruction. Choledochojejunostomy (Roux-en-Y) and gastrectomy (Billorth-II) were considered advantageous for favorable long-term bile drainage and to prevent hematemesis. Splanchnicetomy proved to alleviate pain in 87.5% and is recommended to perform at the time of initial laparotomy. Postoperative adjuvant chemotherapy was performed in 40% of the cases. Arterial infusion chemotherapy was found most effective to prolong survival. The patients who received palliative treatment survived 6.5 months on the average: Mean survival was 7.3 months in the former cases and 3.8 in the latter. Six patients (12%) survived more then one year, and no significant difference in location or size could be found.

Adult↗
PubMed1992

[Palliative treatment of rectal and sigmoid cancer with Nd-YAG laser].

Nd-YAG laser treatment was employed as palliative treatment in 47 patients with colorectal cancer. Thirty-eight patients (81%) experienced good symptomatic effect from the treatment. Four complications occurred: three cases of perforation and one case of moderate bleeding. There was no mortality. It is concluded that laser treatment is a good palliative method in patients with colorectal cancer, especially in elderly patients with complicating diseases and in patients with local recurrence or symptoms from nonresected tumours.

Adult↗
PubMed1992

Intraarterial 5-FU-infusion and simultaneous radiotherapy as palliative treatment of recurrent rectal cancer.

Palliative treatment of recurrent rectal cancer remains to be a challenge. From 1989 to 1991 13 patients with recurrent rectal cancer were treated with intraarterial infusion of 5-Fluorouracil and simultaneous radiotherapy in a palliative intent. Seven patients had received postoperative adjuvant radiotherapy with 56 to 60 Gy. Three patients had been treated with systemic chemotherapy. Radiotherapy of the recurrence was performed with 19.8 to 30.6 Gy in the pre-irradiated patients and with 50.4 to 59.4 Gy in the others. One complete remission, three partial remissions and nine minor responses were observed. Three patients had complete pain relief after the treatment, in the remaining patients major pain reduction was achieved. Palliation lasted from three to twelve months (median: five months). Our results indicate that locoregional chemo- and radiotherapy are a effective modality in recurrent rectal cancer.

Adult↗
PubMed1987

Oesophagogastric tumour in old age: palliative treatment by endoscopic laser photocoagulation.

The results of palliative treatment, with laser photocoagulation used alone, of oesophagogastric tumours in 23 patients mean age 81.9 (range 75-93) years are reviewed. Most were frail including five with metastatic disease, seven with cardiovascular disease and five with cerebrovascular disease. Dysphagia was the presenting symptom in 21 patients, two presented with an acute haematemesis. Improvement in swallowing was achieved in 19 (90.5%). Hospital stay was minimal, and 93.3% deaths were in the community. The only complication was perforated oesophagus in 1 patient, treated successfully by conservative management. We suggest laser photocoagulation as the palliative treatment of choice for dysphagia due to oesophagogastric tumour in the frail elderly patient even when the malignancy is at an advanced stage. The major benefit of the technique is the ability to maintain patients comfortably in the community rather than committing them to terminal care in a hospital environment.

Aged↗
PubMed1999

Peripheral hepatojejunostomy as palliative treatment for irresectable malignant tumors of the liver hilum.

OBJECTIVE: To evaluate the concept of surgical decompression of the biliary tree by peripheral hepatojejunostomy for palliative treatment of jaundice in patients with irresectable malignant tumors of the liver hilum. SUMMARY BACKGROUND DATA: Jaundice, pruritus, and recurrent cholangitis are major clinical complications in patients with obstructive cholestasis resulting from malignant tumors of the liver hilum. Methods for palliative treatment include endoscopic stenting, percutaneous transhepatic drainage, and surgical decompression. The palliative treatment of choice should be safe, effective, and comfortable for the patient. METHODS: In a retrospective study, surgical technique, perioperative complications, and efficacy of treatment were analyzed for 56 patients who had received a peripheral hepatojejunostomy between 1982 and 1997. Laparotomy in all of these patients had been performed as an attempt for curative resection. RESULTS: Hepatojejunostomy was exclusively palliative in 50 patients and was used for bridging to resection or transplantation in 7. Anastomosis was bilateral in 36 patients and unilateral in 20. The 1-month mortality in the study group was 9%; median survival was 6 months. In patients surviving >1 month, a marked and persistent decrease in cholestasis was achieved in 87%, although complete return to normal was rare. Among the patients with a marked decrease in cholestasis, 72% had no or only mild clinical symptoms such as fever or jaundice. CONCLUSIONS: Peripheral hepatojejunostomy is a feasible and reasonably effective palliative treatment for patients with irresectable tumors of the liver hilum. In patients undergoing exploratory laparotomy for attempted curative resection, this procedure frequently leads to persistent-although rarely complete-decompression of the biliary tree. In a few cases it may also be used for bridging to transplantation or liver resection after relief of cholestasis.

Adult↗
PubMedDate not supplied

Comparative post-operative study of prostheses, with and without an anti-reflux valve system, in the palliative treatment of esophageal carcinoma.

BACKGROUND/AIMS: Palliative treatment of advanced esophageal carcinoma by esophageal tunnelization with a prosthesis allows immediate relief of dysphagia. However, the procedure is subject to a high rate of morbidity, including gastroesophageal reflux (GER) present in all patients with a prosthesis positioned through the gastroesophageal junction, resulting in complications (pyrosis, aspiration pneumonias, sleep disorders) and reduced quality of life in these patients who already have a lower rate of survival. In an attempt to reduce GER and its complications, the authors created a surgical prosthesis coupled to an anti-reflux valve system, comparing it to the use of an esophageal prosthesis without an anti-reflux valve mechanism. METHODOLOGY: Twenty-two patients were allocated to 2 tunnelization groups: esophageal prosthesis without an anti-reflux valve mechanism (group 1) and surgical prosthesis coupled to an anti-reflux valve system (group 2). The GER was quantified measuring esophageal-gastric pH, and using fluoroscopy, contrast radiographs and esophageal emptying scintigraphy. Initially, the pH of secretions in S1 (esophagus) and S2 (stomach) was determined using reagent strips after aspirating their contents with different syringes. First with the patient seated at rest in bed, later performing a Valsalva maneuver, deep breathing and forced coughing. The same procedure was performed with the patient in left lateral decubitus, right lateral decubitus, and dorsal decubitus with the head of the bed lowered to 20 degrees. After finishing these maneuvers, 15 ml of 1 molar acetic acid were infused through the catheter positioned in the antrum, and, after 5 min, S1 and S2 material sampling was repeated in the same positions as mentioned above. RESULTS: The pH values between the various positions and maneuvers performed in each group separately were not significantly different, but, if we compare the 2 groups, and the secretions obtained in S1 and S2, there was a significant difference in pH measures in all positions. In the patients in group 1, S1 presented a mean pH ranging from 2.87-3.62 in the initial measures, and between 2.17 and 3.5 after the infusion of 15 ml of 1 molar acetic acid. On the other hand, in group 2, the mean pH of S1 remained between 6.34 and 8.32 in the initial measures and between 4.99 and 7.33 in the presence of acid infusion. At the level of S2, the pH remained unchanged between 2 and 2.7, in both groups. CONCLUSIONS: The authors conclude that the association of an esophageal prosthesis with a valve system significantly reduces GER, as compared with its use alone. Furthermore, it allows marked reduction of the symptoms and resulting complications, and does not interfere clinically with esophageal emptying. It thus significantly improves the quality of life of these patients.

Equipment Failure Analysis↗