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1/14. The management of neuropathic pain in cancer: clinical guidelines for the use of adjuvant analgesics.

    Neuropathic pain is seen in a third of cancer patients and is not always responsive to traditional analgesics. We describe practical guidelines for the use antidepressants and anticonvulsants as adjuvant analgesics in such situations. Newer adjuvant analgesics, interventional procedures and options for the management of pain emergencies, are also briefly outlined.
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2/14. Management of neutropenic enterocolitis in the patient with cancer.

    Neutropenic enterocolitis is a life-threatening condition often seen in patients experiencing prolonged periods of neutropenia from conditions such as leukemia and lymphoma and from aggressive chemotherapy regimens. Its exact pathologic process remains unclear; however, it has been proposed that direct cytotoxic damage occurs to the bowel mucosa with subsequent microbial invasion complicated by the lack of adequate neutrophil response. The damage may progress to bowel perforation and septic shock. Early recognition and management by healthcare team members are crucial for the improved prognosis of these individuals. Controversy continues to exist concerning management options and the timing of these interventions. This article outlines nursing and medical management of the patient with neutropenic enterocolitis.
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3/14. Comprehensive geriatric assessment.

    BACKGROUND: As an adjunct to the general and cancer-specific clinical and diagnostic examinations, comprehensive geriatric assessment (CGA) is an integral tool that examines factors affecting the course of disease and the outcome of treatment. The principal areas of focus of the CGA include the patient's functional, physical, mental, emotional, pharmacotherapeutic, and socioeconomic status. methods: We describe the role of CGA in the identification and management of frail elderly patients. The literature is reviewed to outline the components, programmatic configurations, and process of CGA. Information from systematic reviews of clinical trials of different CGA program models is summarized, and observations relating to the research agenda concerning the applicability of CGA and CGA principles to management of older cancer patients are discussed. RESULTS: Since age itself is not predictive of outcome in an elderly cancer patient, the CGA helps to distinguish between elderly patients who should be treated with intent to cure and those who will benefit from clinical oncologic and geriatric co-management. CONCLUSIONS: A more accurate evaluation of prognostic indicators that includes CGA parameters could lead to a higher number of older patients being included in clinical cancer trials and being treated effectively in practice. It would also identify those who would benefit from gero-oncologic CGA and ongoing management aimed at maintaining function and community living.
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4/14. Clinical experience with anti-EGFR therapy.

    OBJECTIVES: To review clinical experience and studies with anti-EGFR therapies in metastatic CRC, SCCHN, and NSCLC. Case studies in each tumor type will also be outlined. DATA SOURCES: research articles and patient case histories. CONCLUSION: Several phase II/III trials have shown the activity of anti-EGFR therapy in CRC, SCCHN, and NSCLC. Treatment confers substantial clinical benefit with improved symptoms, particularly in previously treated patients. Toxicity of anti-EGFR therapies is generally manageable and non-overlapping with other treatment options, including chemotherapy and radiotherapy. IMPLICATIONS FOR nursing PRACTICE: It is important for nurses to further advance our understanding of anti-EGFR therapies and continue to encourage patient enrollment in ongoing trials of anti-EGFR therapy.
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5/14. Coping with cancer through self-instruction: a hypothesis.

    Because most cancer patients seem to cope well with the stresses of their illness, including the psychosocial ramifications, it is important to understand what good copers manage to do, as opposed to those patients who simply defend themselves against persistent problems. This requires making a radical distinction between coping and defending, as well as between healthy adaptive resources and latent pathological dispositions. A case report is presented to illustrate how one "supercoper" solved problems by self-instruction. While cognitive self-instruction may not be applicable for every cancer patient and all problems, it is a working hypothesis deserving of further investigation, since self-control and personal responsibility are essential elements in rehabilitation on all levels. One intervention model for "high distress" cancer patients is outlined.
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6/14. Cognitive-behavioral interventions in management of cancer pain: principles and applications.

    Cognitive-behavioral interventions are effective for symptoms control and reduction of suffering in cancer pain patients. This article outlines the theoretical and technical principles of these nonmedical interventions and illustrates their integrated application with two case reports.
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7/14. Thin-needle aspiration biopsy. A personal experience with 469 cases.

    The thin-needle aspiration biopsy technic was used in 469 cases to diagnose benign and malignant tumors. The success of the technic depends upon careful examination of the lesion to be biopsied and attention to the details outlined in procuring the aspiration material and preparing the smears. The most important technical consideration is creating a simulated tissue pattern in the preparation of the smears. Routine Papanicolaou, May-Grunwald-Giemsa, metachrome B, and hematoxylin and eosin stains are all useful. Special stains may provide additional evidence for specific diagnoses. lymph nodes were the most common tissue examined by aspiration biopsy in this series. It was possible to identify the primary tumor site from the aspiration smear in most of the cases. Forty-seven breast cancers were identified from 127 aspiration biopsies of breast lumps. breast aspirations are the most difficult to interpret, and no deviation from classic malignant smears should be attempted. The false-negative rate for breast aspirations was 7.0%. No delay in treatment occurred because of a false-negative report. Patient acceptance of the procedure was excellent.
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8/14. Neurologic complications of systemic cancer.

    Neurologic complications of systemic cancer may result from metastatic spread of tumor to the central nervous system, from paraneoplastic effects of peripheral tumor, or from side effects of anticancer therapy. This article outlines currently available data on clinical presentations of these complications and diagnostic modalities for their recognition, data which may help the clinician ameliorate the often devastating sequelae of these neurologic complications.
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9/14. Identification of squamous cell carcinoma of the head and neck by tissue culture and immunological testing.

    We outline the techniques used to successfully grow squamous cell carcinoma in tissue culture, and to test the cellular immunity of the patient by lymphocyte cytotoxicity studies. lymphocytes cultured with malignant squamous cells killed from 40 to 60 percent of the tumor cells during 48 hours of incubation. These same lymphocytes did not show any killing potential against cultured melanoma cells or against cultured fibroblasts. This demonstrates an immune response that is tumor-antigen specific. There was no evidence of any serum-blocking factor, because the killing potential of these lymphocytes was not significantly altered by the addition of the patients' sera. The implications and potential for early diagnosis made possible by these techniques are discussed.
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10/14. delirium in terminally ill cancer patients.

    Nineteen patients believed to be in the terminal stages of cancer were evaluated for signs of delirium. Six patients improved; 13 who died during hospitalization were studied until their death. patients were interviewed three times a week using a delirium scale; medical records also were used to gather data. Eleven (85%) of the 13 patients developed delirium. In most patients, delirium was caused by multiple factors. The authors outline strategies for management of terminal cancer patients with delirium.
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