Palliative Gastrointestinal Surgery

2019 ◽  
pp. 175-182
Author(s):  
Brian Badgwell
Keyword(s):  
Quality Of Life ◽  
Gastrointestinal Cancer ◽  
Bowel Perforation ◽  
Gastrointestinal Surgery ◽  
Optimal Management ◽  
Critical Component ◽  
Gastrointestinal Malignancies ◽  
Common Diagnosis ◽  
Surgical Palliation

Palliative surgical consultation is a critical component of multidisciplinary gastrointestinal cancer care. For many types of gastrointestinal malignancies, the majority of patients are not able to achieve cure and develop symptoms attributable to their advanced or incurable malignancy. The most common diagnosis is bowel obstruction, but diagnoses such as bowel perforation, hemorrhage, neutropenia and abdominal pain, and anorectal infections are also included. Safe utilization of surgical intervention can be difficult due to the increased risks of surgery, limited therapeutic options for these complex palliative care situations, and the progressive nature of incurable gastrointestinal cancer. In selected patients, surgical palliation can improve symptoms and quality of life with acceptable reported rates of morbidity and mortality. Even in situations where surgery is not offered, an understanding of the disease processes and outcomes can inform patients and other providers in the optimal management strategy.

scholarly journals Reporting on Quality of Life in Randomised Controlled Trials in Gastrointestinal Surgery

2009 ◽  
Vol 14 (1) ◽  
pp. 156-165 ◽  
Author(s):  
Valerie Bridoux ◽  
Grégoire Moutel ◽  
Benoit Lefebure ◽  
Michel Scotte ◽  
Francis Michot ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomised Controlled Trials ◽  
Gastrointestinal Surgery ◽  
Controlled Trials ◽  
Randomised Controlled

scholarly journals Canadian Consensus Conference on the Management of Gastroesophageal Reflux Disease in Adults – Update 2004

2005 ◽  
Vol 19 (1) ◽  
pp. 15-35 ◽  
Author(s):  
David Armstrong ◽  
John K Marshall ◽  
Naoki Chiba ◽  
Robert Enns ◽  
Carlo A Fallone ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Reflux Disease ◽  
Symptom Relief ◽  
Management Strategies ◽  
Consensus Conference ◽  
Optimal Management ◽  
Barrett’S Epithelium ◽  
Barrett's Epithelium ◽  
Gerd Symptoms

BACKGROUND: Gastroesophageal reflux disease (GERD) is the most prevalent acid-related disorder in Canada and is associated with significant impairment of health-related quality of life. Since the last Canadian Consensus Conference in 1996, GERD management has evolved substantially.OBJECTIVE: To develop up-to-date evidence-based recommendations relevant to the needs of Canadian health care providers for the management of the esophageal manifestations of GERD.CONSENSUS PROCESS: A multidisciplinary group of 23 voting participants developed recommendation statements using a Delphi approach; after presentation of relevant data at the meeting, the quality of the evidence, strength of recommendation and level of consensus were graded by participants according to accepted principles.OUTCOMES: GERD applies to individuals who reflux gastric contents into the esophagus causing symptoms sufficient to reduce quality of life, injury or both; endoscopy-negative reflux disease applies to individuals who have GERD and a normal endoscopy. Uninvestigated heartburn-dominant dyspepsia -- characterised by heartburn or acid regurgitation - includes erosive esophagitis or endoscopy-negative reflux disease, and may be treated empirically as GERD without further investigation provided there are no alarm features. Lifestyle modifications are ineffective for frequent or severe GERD symptoms; over-the-counter antacids or histamine H2-receptor antagonists are effective for some patients with mild or infrequent GERD symptoms. Proton pump inhibitors are more effective for healing and symptom relief than histamine H2-receptor antagonists; their efficacy is proportional to their ability to reduce intragastric acidity. Response to initial therapy - a once-daily proton pump inhibitor unless symptoms are mild and infrequent (fewer than three times per week) - should be assessed at four to eight weeks. Maintenance medical therapy should be at the lowest dose and frequency necessary to maintain symptom relief; antireflux surgery is an alternative for a small proportion of selected patients. Routine testing for Helicobacter pylori infection is unnecessary before starting GERD therapy. GERD is associated with Barrett's epithelium and esophageal adenocarcinoma but the risk of malignancy is very low. Endoscopic screening for Barrett's epithelium may be considered in adults with GERD symptoms for more than 10 years; Barrett's epithelium and low-grade dysplasia generally warrant surveillance; endoscopic or surgical management should be considered for confirmed high-grade dysplasia or malignancy.CONCLUSION: Prospective studies are needed to investigate clinically relevant risk factors for the development of GERD and its complications; GERD progression, on and off therapy; optimal management strategies for typical GERD symptoms in primary care patients; and optimal management strategies for atypical GERD symptoms, Barrett's epithelium and esophageal adenocarcinoma.

scholarly journals Development and Validation of a Multidisciplinary Mobile Care System for Patients With Advanced Gastrointestinal Cancer: Interventional Observation Study (Preprint)

2017 ◽  
Author(s):  
Ji Yeong Soh ◽  
Won Chul Cha ◽  
Dong Kyung Chang ◽  
Ji Hye Hwang ◽  
Kihyung Kim ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Colon Cancer ◽  
Gastrointestinal Cancer ◽  
Response Rate ◽  
Self Monitoring ◽  
Satisfaction Rate ◽  
Cancer Group ◽  
Care System

BACKGROUND Mobile health apps have emerged as supportive tools in the management of advanced cancers. However, only a few apps have self-monitoring features, and they are not standardized and validated. OBJECTIVE This study aimed to develop and validate a multidisciplinary mobile care system with self-monitoring features that can be useful for patients with advanced gastrointestinal cancer. METHODS The development of the multidisciplinary mobile health management system was divided into 3 steps. First, the service scope was set up, and the measurement tools were standardized. Second, the service flow of the mobile care system was organized. Third, the mobile app (Life Manager) was developed. The app was developed to achieve 3 major clinical goals: support for quality of life, nutrition, and rehabilitation. Three main functional themes were developed to achieve clinical goals: a to-do list, health education, and in-app chat. Thirteen clinically oriented measures were included: the modified Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events questionnaire, Scored Patient-Generated Subjective Global Assessment (PG-SGA), distress, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, International Physical Activity Questionnaire–Short Form, Low anterior resection syndrome score, satisfaction rate, etc. To validate the system, a prospective observational study was conducted. Patients with gastric cancer or colon cancer undergoing chemotherapy were recruited. We followed the subjects for 12 weeks, and selected clinical measures were taken online and offline. RESULTS After the development process, a multidisciplinary app, the Life Manager, was launched. For evaluation, 203 patients were recruited for the study, of whom 101 (49.8%) had gastric cancer, and 102 (50.2%) were receiving palliative care. Most patients were in their fifties (35.5%), and 128 (63.1%) were male. Overall, 176 subjects (86.7%) completed the study. Among subjects who dropped out, the most common reason was the change of patient’s clinical condition (51.9%). During the study period, subjects received multiple health education sessions. For the gastric cancer group, the “general gastric cancer education” was most frequently viewed (322 times), and for the colon cancer group, the “warming-up exercise” was most viewed (340 times). Of 13 measurements taken from subjects, 9 were taken offline (response rate: 52.0% to 90.1%), and 3 were taken online (response rate: 17.6% to 57.4%). The overall satisfaction rate among subjects was favorable and ranged from 3.93 (SD 0.88) to 4.01 (SD 0.87) on the 5-point Likert scale. CONCLUSIONS A multidisciplinary mobile care system for patients with advanced gastrointestinal cancer was developed with clinically oriented measures. A prospective study was performed for its evaluation, which showed favorable satisfaction.

scholarly journals Quality of Life and Symptom Control after Stent Placement or Surgical Palliation of Malignant Colorectal Obstruction

2010 ◽  
Vol 210 (1) ◽  
pp. 45-53 ◽  
Author(s):  
Satish Nagula ◽  
Nicole Ishill ◽  
Carla Nash ◽  
Arnold J. Markowitz ◽  
Mark A. Schattner ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Stent Placement ◽  
Symptom Control ◽  
Colorectal Obstruction ◽  
Surgical Palliation

Self-Management of Multiple Sclerosis

2017 ◽  
pp. 382-405
Author(s):  
Malachy Bishop ◽  
Michael Frain
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Psychosocial Functioning ◽  
Self Management ◽  
Effective Practices ◽  
Health And Wellness ◽  
Critical Component ◽  
Research Directions ◽  
Neurological Condition

Multiple sclerosis (MS) is a chronic neurological condition that can impact one’s health and functioning, role participation, and quality of life in a wide variety of ways. Self-management is increasingly recognized as a critical component of MS care and a person-directed approach to health and wellness. Given the range of ways that MS may affect physical and cognitive as well as psychosocial functioning, effective and comprehensive MS self-management may require a broad range of knowledge and resources. Thus this chapter explores current perspectives on MS self-management, evaluates the research evidence and current research directions, and identifies effective practices in MS self-management.

PS02.229: ASSESSMENT OF VARYING QUALITY OF LIFE OUTCOMES BASED ON A STRATEGY OF ORGAN PRESERVATION VERSUS SURGERY FOR UPPER GASTROINTESTINAL MALIGNANCIES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 187-187
Author(s):  
Lauren O Connell ◽  
Mary Coleman ◽  
Natalia Kharyntiuk ◽  
Thomas Walsh
Keyword(s):  
Quality Of Life ◽  
Conflicts Of Interest ◽  
External Validation ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Disease Stage ◽  
Control Group ◽  
Gastrointestinal Malignancies ◽  
Upper Gastrointestinal

Abstract Background: Background Neoadjuvant chemoradiotherapy (naCRT) for upper gastrointestinal malignancies induces a pathological complete response (pCR) in 25–85% of patients, depending on disease stage and regimen chosen. All patients with a pCR will have a clinical complete response (cCR). Avoidance of surgery is desirable where feasible, as operative intervention entails morbidity and mortality risks and a reduction in lifelong health related quality of life (HRQoL). Pursuant on a policy of permitting selected patients with a cCR to opt for surveillance, this study aims to compare the QoL of patients who chose surveillance over adjuvant surgery following a cCR to naCRT. Methods: Methods One hundred and fourteen patients participated in the study. These comprised 4 groups; Group 1 (n = 31) were healthy controls; Group 2 (n = 26) had chemoradiotherapy only; Group 3 (n = 31) had oesophagectomy post naCRT and Group 4(n = 26) had gastrectomy alone. A novel 33 point questionnaire assessing 5 functional domains was completed focusing on symptoms of antro-pyloric function, respiratory reflux and post-vagotomy symptoms, as well as a previously validated questionnaire instrument for purposes of comparison and external validation. The data was aggregated to produce a total score ranging from 20–93 with 20 representing the least symptomatic. Results: Results Mean(± sd) overall QoL scores were significantly better in patients avoiding resection (28.9 ± 4.5) vs oesophagectomy (32.3 ± 58. P = 0.042) and vs gastrectomy(33.19 ± 5.9, P = 0.004. Scores did not differ between patients undergoing oesophagectomy or gastrectomy (P = 0.889). Oesophagectomy was associated with a trend towards increased reflux-related respiratory symptoms (7.3 ± 2.2 vs 6.5 ± 1.9; P = 0.396) while gastrectomy patients reported more symptoms related to vagotomy (1.82 ± 0.9 vs 1.4 ± 0.6; P = 0.438) and early dumping (8.2 ± 1.4 vs 7.1 ± 1.7; P = 0.239). The mean score for the control group administered the novel questionnaire was 20.74, approaching the lowest possible score of 20. This was significantly lower than any of the scores recorded for the treatment groups (P = < 0.001). Conclusion: Discussion A strategy of active surveillance in complete responders to neoadjuvant chemoradiotherapy is rewarded with a superior quality of life than in those undergoing surgery. Disclosure All authors have declared no conflicts of interest.

scholarly journals What is the optimal management of paraduodenal pancreatitis? Surgery is associated with higher incidence of diabetes but similar quality of life and pain control

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S218-S219
Author(s):  
A. Balduzzi ◽  
G. Marchegiani ◽  
S. Andrianello ◽  
F. Romeo ◽  
A. Amodio ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Control ◽  
Optimal Management ◽  
Paraduodenal Pancreatitis

Chemotherapy-Induced Nausea and Vomiting Incidence and Prevalence

2012 ◽  
pp. 541-543 ◽  
Author(s):  
Steven M. Grunberg
Keyword(s):  
Quality Of Life ◽  
Patient Experience ◽  
Nausea And Vomiting ◽  
Physician Education ◽  
Optimal Management ◽  
Effective Management ◽  
Optimal Maintenance ◽  
The Impact

Overview: Although chemotherapy-induced nausea and vomiting is recognized as having been an important problem during the initial introduction of chemotherapy into the antineoplastic armamentarium, the assumption that this problem has already been solved can restrict optimal management and further advances. Underestimation of nausea and vomiting may have many causes. If these toxicities are assumed to be necessary properties of chemotherapy, then their incidence may be taken for granted. If nausea and vomiting appear after discharge from the clinic several days after chemotherapy, these toxicities may not be reported because of poor recall or because of efforts by patients to avoid unnecessary complaints. Physician education may be compromised if physicians see nausea and vomiting as population problems but not problems for their own patients. Failure to recognize nausea and vomiting as two distinct entities that may appear independently of each other can also limit understanding of the prevalence of these problems and efforts at effective management. Continued attention to the impact of nausea and vomiting on the patient experience will be necessary to insure optimal maintenance of quality of life.

Management of diet in gastrointestinal cancer

2020 ◽  
pp. 1-8
Author(s):  
Clare Shaw
Keyword(s):  
Quality Of Life ◽  
Dietary Intake ◽  
Cancer Treatment ◽  
Gastrointestinal Cancer ◽  
Late Effects ◽  
Complex Interventions ◽  
Metabolic Effects ◽  
Dietary Advice ◽  
Future Research

Nutrition and gastrointestinal cancer are inextricably linked. The metabolic effects of cancer along with changes in dietary intake, the development of cancer cachexia and the presence of sarcopenia can influence changes in body composition. These have a negative impact on quality of life and tolerance to cancer treatment. Treatment for cancer presents some significant nutritional challenges as nutrition impact symptoms may develop, be exacerbated by treatment and may contribute to a worsening in nutritional status. Nutrition screening and assessment should be an integral part of holistic patient care. The provision of appropriate, evidence-based dietary advice should occur before, during and after cancer treatment. Appropriate and timely methods of nutritional support across the spectrum of gastrointestinal cancer are needed to ensure that people are adequately supported during courses of treatment that can span weeks and months. These can range from standard approaches of supplementing oral intake to complex interventions such as managing high output intestinal stomas. The gastrointestinal tract is particularly susceptible to impact from systemic anti-cancer treatments and radiotherapy. Gastrointestinal late effects of cancer treatment are now recognised to present particular challenges in terms of both medical and nutritional management. These late effects have a significant impact on the individual and their quality of life in addition to implications for the health service. Dietary intake following cancer treatment has an impact on quality of life and future research may demonstrate its influence on the risk of recurrence of gastrointestinal cancer.

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