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1/34. An integrated model of group treatment for cancer patients.

    Considerable evidence suggests that group interventions are a valuable resource for cancer patients, but few conceptual frameworks are available to guide decisions about which approaches might be most useful for which patients at what phases of illness. This article presents an integrative treatment model for group services. It describes different group interventions geared toward patients at different phases of illness to accommodate the shifting needs and concerns that evolve over the course of the disease. Recommendations are offered concerning further research and model development.
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2/34. Phase I trial of 6-hour infusion of glufosfamide, a new alkylating agent with potentially enhanced selectivity for tumors that overexpress transmembrane glucose transporters: a study of the European Organization for research and Treatment of Cancer Early Clinical Studies Group.

    PURPOSE: To determine the maximum-tolerated dose (MTD), the principal toxicities, and the pharmacokinetics of 6-hour infusion of glufosfamide (beta-D-glucosylisophosphoramide mustard; D-19575), a novel alkylating agent with the potential to target the glucose transporter system. patients AND methods: Twenty-one patients (10 women and 11 men; median age, 56 years) with refractory solid tumors were treated with doses ranging from 800 to 6,000 mg/m(2). Glufosfamide was administered every 3 weeks as a two-step (fast/slow) intravenous infusion over a 6-hour period. All patients underwent pharmacokinetic sampling at the first course. RESULTS: The MTD was 6,000 mg/m(2). At this dose, two of six patients developed a reversible, dose-limiting renal tubular acidosis and a slight increase in serum creatinine the week after the second and third courses of treatment, respectively, whereas three of six patients experienced short-lived grade 4 neutropenia/leukopenia. Other side effects were generally mild. pharmacokinetics indicated linearity of area under the time-versus-concentration curve against dose over the dose range studied and a short elimination half-life. There was clear evidence of antitumor activity, with a long-lasting complete response of an advanced pancreatic adenocarcinoma and minor tumor shrinkage of two refractory colon carcinomas and one heavily pretreated breast cancer. CONCLUSION: The principal toxicity of 6-hour infusion of glufosfamide is reversible renal tubular acidosis, the MTD is 6,000 mg/m(2), and the recommended phase II dose is 4, 500 mg/m(2). Close monitoring of serum potassium and creatinine levels is suggested for patients receiving glufosfamide for early detection of possible renal toxicity. Evidence of antitumor activity in resistant carcinomas warrants further clinical exploration of glufosfamide in phase II studies.
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3/34. The significant unmet needs of cancer patients: probing psychosocial concerns.

    'Significant unmet needs' are those needs that patients identify as both important and unsatisfied. In this article we ask whether the overall needs of cancer patients are actually being met. We believe that the range of unmet need, and the kinds of patients who are more likely to claim unmet need, should be carefully identified. The needs responses of a series of 295 cancer patients in a cross-sectional survey were analysed. The majority expressed the opinion that information and good relationships with health care professionals were important, and few expressed dissatisfaction with these aspects of need. Similarly, needs items about support from family and friends were largely rated as important and satisfied. For a sizeable minority of patients, items of significant unmet need cluster around aspects of managing daily life, emotions, and social identity. The distribution of significant unmet needs is not random but is more likely to be experienced by patients who are younger, have a long-standing illness or disability, do not own/have use of a car, and/or have no religious faith. Furthermore, significant unmet needs relate to patients' ability to talk freely to a carer about the cancer, the degree to which the cancer interferes with social activities, and whether financial difficulties are experienced. Most of the significant unmet need is beyond the remit of services primarily designed for the treatment of disease. We consider whether multidisciplinary cancer teams can be expected to deal with all aspects of the cancer experience.
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4/34. Recognizing spiritual distress.

    Recent research suggests that while attending worship services may extend life, spiritual distress may cut lives shorter. Although authors of this research agree that more study is needed, they recognize that elderly ill men and women who experience a religious struggle with their illnesses appear to be at risk for an earlier death, even after controlling for baseline health, mental health, and demographic factors. This article examines the patient-professional relationship within the framework of virtue ethics and spiritual distress. A case study is presented.
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5/34. Conversion from intrathecal morphine to oral methadone.

    BACKGROUND AND OBJECTIVES: methadone is an inexpensive and highly effective analgesic when titrated appropriately. Its equianalgesic ratio with other opioids is variable, however. We present a case of conversion from high-dose intrathecal (IT) morphine to oral methadone. CASE REPORT: A 37-year-old man was admitted to the orthopedic service due to increased lower back pain. He had a history of recurrent L5 plasmacytoma, an L5 corpectomy, and L3-S1 fusion with instrumentation. An implanted neuraxial drug delivery device had been placed at another institution for back pain. Evaluation suggested infection involving the hardware. The patient underwent hardware removal, debridement of osteomyelitis, and removal of the IT catheter. The patient's analgesia was converted from IT to intravenous morphine and then to oral methadone. CONCLUSIONS: The conversion from high-dose IT morphine to oral methadone has not been previously described. The case presents higher IT morphine to oral methadone conversion ratio than might be expected based upon conventionally used equianalgesic tables.
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6/34. Informed choice in cancer pain: empowering the patient.

    Cancer and palliative care service users can often feel isolated and disempowered. (Tower, 1999). Physical changes, medical interventions and pain can mean that they no longer feel in control of their bodies or their futures. In recognition of this, many health professionals within cancer and palliative care have adopted the mantra of 'patient empowerment', but it is not always clear what it means for either the patients or the professionals. Empowerment is an interactive process that develops and increases power through cooperation, sharing and working together (Marquis and Huston, 2000), and it plays a central role in health professionals' personal and working lives. A person's ability to make decisions and choices demonstrates control of his or her own destiny. This article aims to direct health professionals' participation and involvement in restoring this ability to patients who have pain related to cancer.
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7/34. palliative care provision and its impact on psychological morbidity in cancer patients.

    In response to many influences, palliative care services in the UK are evolving rapidly, and are increasingly challenged to demonstrate equity, access and effectiveness. This article discusses the principles, philosophy and status of palliative care in the UK in the context of recent NHS developments. A case study is employed in order to critically evaluate the implementation of the palliative care approach, focusing on the specific issue of the assessment of anxiety and depression in the cancer setting. The provision of a comprehensive and integrated clinical service is a constant challenge in this patient group. In order to increase awareness and facilitate further development of patient services, and ultimately improve clinical practice, several factors are highlighted. These include the impact of multiprofessional team care, the problems inherent in the diagnosis of depression and the question of whether cancer nurses are adequately prepared to handle patients' psychological morbidity.
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8/34. Stressors associated with pacific islands children diagnosed with cancer and severe blood disorders.

    Pediatric cancer patients from the US-associated pacific islands have the option of referral to the united states for diagnosis and treatment through historical governmental agreements. These patients and their families travel thousands of miles, relocating for extended periods of time, to complete treatment. The purpose of this study is to describe the characteristics of pacific islands children referred for treatment to a pediatric oncology clinic in hawaii, the support services they utilized, and the difficulties they experienced during their relocation. The medical records of 100 children referred from the pacific islands to Kapiolani women's and Children's Hospital in Honolulu, hawaii, between 1981 and 2002 were abstracted to gather data on treatment and service utilization. Interviews were conducted with 17 of these families for a more qualitative description of their experiences. The study found that families face considerable financial, emotional, and cultural stressors when relocating from the pacific islands to Honolulu for pediatric cancer treatment. The support systems currently in place can only partly address the needs of this population.
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9/34. What about the carers?: Exploring the experience of caregivers in a chemotherapy day hospital setting.

    Interest in the concerns of cancer patients' carers has been growing steadily over the last decade reflected in key cancer service policy documents [DOH, 1995. A policy Framework for Commissioning Cancer Services (Calman-Hine Report). london, HMSO; DOH, 2002. The NHS Cancer Plan]. Despite this acknowledgement, it can be argued that less is known about carers' experience in the cancer treatment context. Carers can be defined as someone who shares the experience of cancer with the patient. The aim of this study was to explore the lived experience of caregivers in a chemotherapy day hospital and how this compared with their experience of inpatient care. Using a phenomenological approach, face-to-face interviews were conducted with a purposive sample of ten caregivers. Data were analysed using Polkinghorne's [1995. Narrative Knowing & the Human Sciences. University of new york Press, Albany] two stages of narrative analysis. The findings indicated that the caregivers experienced similar transitions to the patients with regards to health-illness transition and organisational transitions. The caregivers adopted various roles in the day hospital such as Companion 'being with' their relative, Protector 'keeping an eye'; Practical Caregiver and assuming an Advocate role. The findings of this study are important for cancer nursing practice as health professionals need to acknowledge the role of carers in the chemotherapy day hospital setting and facilitate their involvement in care.
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10/34. An inner city cancer prevention clinic. Design, methods, and early results.

    An american cancer society demonstration pilot project is underway that is designed to provide comprehensive cancer prevention-related services to the underserved community of West Oakland, california. An array of cancer prevention services are being made available through an inner-city clinic (West Oakland Health Center), including cancer risk assessments and education about cancer, physical examinations for cancer, teaching of self-examination procedures, smoking cessation, and nutrition counseling, appointments for Pap smears, sigmoidoscopy, mammography, and other more specialized screening procedures, case management for findings suspicious for cancer, and community education programs. Described is the process of implementing these services, their utilization, and their impact (after 6 months).
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