Wednesday, 30 April 2008

JAMA 16 Apr 2008, vol. 299, no. 15

Management of intractable nausea and vomiting in patients at the end of life: I was feeling nauseous all of the time . . . nothing was working.

Full text available at American Medical Association
p. 1826
Markowitz-Amy-J, Rabow-Michael-W.
Comment on: JAMA. 2007 Sep 12; 298(10):1196-207.

Palliative care for patients with head and neck cancer: I would like a quick return to a normal lifestyle.

Full text available at American Medical Association
p. 1818-25
Goldstein-Nathan-E, Genden-Eric, Morrison-R-Sean.
Head and neck cancers constitute a diverse group of diseases including malignancies of the oral cavity, oropharynx, larynx, sinuses, and skull base. Treatment of these cancers includes a combination of surgical resection, chemotherapy, and radiation. Due to both the patterns of disease recurrence and the adverse effects of treatments, patients with head and neck cancer often have a complex and prolonged course of illness that is marked by periods of freedom from disease and symptoms interspersed with bouts of serious illness, debility, and numerous physical and psychological symptoms including pain, dysphagia, weight loss, disfigurement, depression, and xerostomia. Thus, management of this disease is best provided by an interdisciplinary team that includes individuals from the disciplines of otolaryngology, palliative care, radiation oncology, oncology, nutrition, speech, and physical and occupational therapy. Using the case of Mr K, we describe the symptoms encountered by patients with head and neck cancer and suggest options for management. We discuss the psychological aspects that affect these patients, including issues such as changes in body image, quality of life, anxiety, and guilt. Finally, we discuss the importance of the interdisciplinary team in the care of these patients and outline the roles of each team member. By providing comprehensive care to patients with malignancies of the head and neck, clinicians can increase the likelihood that patients and their families will be able to obtain the best possible outcomes and quality of life.

Determining hospice benefit for patients with dementia.

Full text available at American Medical Association
p. 1774; author reply 1774-5
Comment on: JAMA. 2007 Dec 5; 298(21):2527-36.

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