Baseline Karnofsky performance status is independently predictive of death within 30 days of intracranial radiation therapy completion for metastatic disease
Shearwood McClellandNamita AgrawalMay ElbannaKevin ShiueG. BartlettTim LautenschlaegerRichard C. ZellarsGordon A. WatsonSusannah G. Ellsworth
8
Citation
10
Reference
10
Related Paper
Citation Trend
Keywords:
Performance status
As the need for palliative care increases, palliative care is emerging as a field of medical care in its own right. At the same time there are many aspects of palliative care that are problematic, particularly in palliative care education. The aspects reviewed here include: (a) the lack of a long tradition and adequate concep-tualization of palliative care; (b) the significance of psychological, emotional, and spiritual aspects; (c) the importance of but inadequate understanding of symptom control; (d) the fact that palliative care is not curative in the accepted sense; (e) its multiprofessional nature; (f) the range of different settings of palliative care; and (g) the fact that palliative caregivers have to perform their duties in situations where the emotional and psychological demands on them may be immense. A number of general issues relevant to palliative care education are also reviewed.
Cite
Citations (45)
Background: Parkinson’s disease is a common, life-limiting, neurodegenerative condition. Despite calls for improved access to palliative care for people with Parkinson’s disease, services have been slow in developing. Obstacles include poor understanding and recognition of palliative care needs, the role for specialist palliative care services and an agreed structure for sustainable palliative care provision. Aim: To summarise the evidence base for palliative care in Parkinson’s disease, linking current understanding with implications for clinical practice and identifying areas for future research. What is known: Convention recognises a final ‘palliative phase’ in Parkinson’s disease, while qualitative studies suggest the presence of palliative care need in Parkinson’s disease from diagnosis. Clinical tools to quantify palliative symptom burden exist and have helped to identify targets for intervention. Dementia is highly prevalent and influences many aspects of palliative care in Parkinson’s disease, with particular implications for end-of-life care and advance care planning. Implications for clinical practice: The ‘palliative phase’ represents a poor entry point for consideration of palliative care need in Parkinson’s disease. An alternative, integrated model of care, promoting collaboration between specialist palliative and neurological services, is discussed, along with some specific palliative interventions. What is unknown: Limited evidence exists regarding timing of palliative interventions, triggers for specialist referral and management of terminal care. Implications for future research: Research examining access to palliative care and management of terminal symptoms will assist development of sustainable, integrated palliative care services for Parkinson’s disease.
Curative care
Cite
Citations (78)
This chapter contains sections titled: Introduction The great debate: surgery versus radiotherapy Surgery plus adjuvant radiotherapy How does radiotherapy work? Methods of radiotherapy administration Radiotherapy simulation and planning Radiotherapy treatment factors Optimising radiotherapy treatment Treatment-related toxicities Acute radiotherapy toxicities Late radiotherapy toxicities Second malignancies Radiotherapy and quality of life Conclusion Frequently asked questions Resources References
Adjuvant radiotherapy
Cite
Citations (0)
Objective:To study on whether radiotherapy affects on T cell subgroups,and to research on the effects of immunoenhancing agents on the immune side effects of radiotherapy.Methods:Sixty-six malignant tumour patients were divided into two groups,radiotherapy alone and radiotherpay plus immunoinhancing agents therapy groups.All patients were subjected to high energy X-rays and electronic rays outer local reginal therapy.T cell subgroups levels were measured before and after the radiotherapy.Results:CD 3,CD 4 and CD 8 decreased significantly after radiotherapy (P0.05) in radiotherapy alone group.There were no differences in CD 3,CD 4 and CD 8 before and after radiotherapy in the group of radiotherapy plus immunoinhancing agents therapy.Conclusions:Radiotherapy may cause the decrease in T cells of all subgroups and immunoinhancing agents may antagonize the side effects of radiotherapy. [
Cite
Citations (0)
Cite
Citations (16)
Univariate
Recursive partitioning
Univariate analysis
Performance status
Cite
Citations (86)
Consecutive series involving 172 patients with small cell lung cancer were analyzed retrospectively using eight pretreatment and two treatment-related prognostic factors in respect of their influence on survival. All the patients received chemotherapy with or without chest irradiation, according to phase II or phase III trial protocols of the National Cancer Center Hospital, Tokyo, from 1970 to 1987. The influence on survival of the various factors was investigated using univariate methods and Cox's proportional hazards model. In patients who survived for more than one year, a performance status of 0-1, limited disease, an age greater than 60 years, the absence of liver metastasis, radiotherapy to primary site and response to chemotherapy were determined by univariate analysis to be favorable prognostic factors. By multivariate analysis, performance status (P = 0.005), age (P = 0.026) and response to induction chemotherapy (P = 0.0001) proved to be valuable prognostic survival factors. The extent of disease which had been considered one of the most significant prognostic factors, was shown not to be a significant independent variable by multivariate analysis. Staging procedures may influence the prognostic analysis. Although classifying the limited or extensive stage of disease is still recommended, the current staging system lacks stringency and may not, in fact, reflect the tumor burden accurately. A simpler and meaningful staging system needs to adopted universally in order to continue the build-up of data for comparison from all institutions.
Univariate analysis
Univariate
Performance status
Prognostic variable
Cite
Citations (11)
Univariate analysis
Performance status
Karnofsky Performance Status
Recursive partitioning
Cite
Citations (68)
Palliative care in the Netherlands is growing and the climate for further development is favourable. Although there is a great deal of consensus on the current debates within palliative care, important disagreements persist. These disagreements relate to the history of palliative care within the country, the scope of palliative care, its values, the appropriate institutional context, and the moral acceptability of euthanasia in palliative care. In this paper, the consensus and the disagreements are described and discussed. It is concluded that many disagreements emerge from so-called external goals of palliative care. It is recommended that the debate should refocus on the internal goal of palliative care, which is the quality of life of the patient and his or her loved ones.
Scope (computer science)
Cite
Citations (37)
To predict the prognostic factors and to improve the response and survival in intermediate-grade and high-grade non-Hodgkin lymphoma (NHL).200 patients with intermediate-grade and high-grade NHL were treated with chemotherapy. A multivariate Cox model was used to analyse the prognostic factors that significantly affect the treatment outcome. The variables examined included: sex, age, clinic stage of disease, B symptoms, extranodal sites, bone marrow involvement, tumor bulk, performance status (ECOG) and malignancy grades.Multivariate analysis showed that performance status, the number of extranodal sites, pathologic malignancy grade and tumor bulk were significantly independent prognostic factors. These factors were put together to construct a prognostic index formula. The index partitioned the patients into low risk group (PI -2.43(-)-1.30), intermediate risk group (PI -1.29-1.0) and high risk group (PI > 1.0) giving 5-year survival rates of 76.0%, 21.6% and 7.4%, respectively.The prognostic index formula and subgroups could serve as a reference to distinguish patients requiring more intensive chemotherapy and autologous stem cell transplantation from those who should be treated with standard regimens in order to improve the prognosis.
Performance status
International Prognostic Index
Autologous stem-cell transplantation
Prognostic variable
Cite
Citations (0)