Lege Artis Medicinae

[Indications of palliative radiotherapy]

POLGÁR Csaba

JUNE 20, 2003

Lege Artis Medicinae - 2003;13(05)

[Radiotherapy - as a part of complex, multidisciplinary therapy - indicated in 70% of patients with malignant tumors during the natural course of the disease. Unfortunately, around 40-50% of patients can not be cured due to the advanced stage, recurrence or dissemination of the disease. In such cases radiotherapy with palliative intention can be used to resolve symptoms, decrease tumor burden and increase the quality of life for the patient. Urgent radiotherapy can overcome special symptoms causing acute life-threatening conditions. The author reviews the main indications, radiotherapy techniques, dose-fractionation schedules and treatment results of palliative and urgent radiotherapy used in the daily clinical practice.]

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Lege Artis Medicinae

[Therapy of high-intensity cancer pain]

SIMKÓ Csaba

[Although cancer pain is usually a chronic one, in certain cases it needs emergency treatment due to its intensity. By the temporal appearance of pain the author discusses separately the possibilities of treatment of the continuous and the episodic (breakthrough) pain and refers particularly to the neuropathic pain. It is stressed that opiate-responsive continuous severe pain can be diminished most quickly by giving morphine intravenously and a recommendation is drafted how to perform it rapidly but safely. Finally, it is emphasized that the absence of pain analysis and appropriate drug therapy is the most important factor of inadequate pain relief up to now.]

Lege Artis Medicinae

[What is personal and what is not]

PÖRCZI Zsuzsanna

Lege Artis Medicinae

[Easing nausea and vomiting in terminally ill cancer patients]

SIMKÓ Csaba

[Nausea and vomiting are very frequent problems in terminally ill cancer patients, with many causes in the background. Repeated vomiting considerably affects patients' quality of life and may also cause numerous complications requiring hospitalization. In palliative care these symptoms need to be alleviated knowing that triggering causes persist. To provide effective symptom control we need to understand the triggering mechanism of vomiting as well as to have a deep knowledge of most important antiemetics and to give efficient drugs regularly.]

Lege Artis Medicinae

[Palliative chemotherapy of solid tumors]

TELEKES András, HEGEDŰS Márta

[Palliative chemotherapy, as defined, a cytotoxic treatment where the expected result is not sufficient enough to cure the patient but it could relieve the cancer related symptoms. In other words, it is such a treatment where the chance of symptomatic improvement means an overall advantage to the patient compared to the possible disadvantages of toxicity. In the 70s and 80s, only the objective response rate, relapse free interval, and overall survival rates were selected as endpoints when the activity of anticancer agents were investigated. In these studies it was observed that a considerable amount of patient showed significant symptomatic improvement even though the treatment was ineffective according to the measured endpoints. Today, the measurement of quality of life is one of the standard endpoint of such studies. Moreover, quality of life is considered as the most important independent factor when palliative chemotherapy is initiated. It should be noted that remission is not the only and final benefit of chemotherapy. The role and options of palliative chemotherapy in certain tumors are discussed.]

Lege Artis Medicinae

[End-of-life care]

GRABER Hedvig, MAGYAR Tamás

[Recently, physicians and medical literature are more concerned about end-of-life care. A review is given of studies dealing with the rights of the dying patient, with advance directives and with possible treatments in the last days of life. A survey was done in author's department on medical therapy of the terminal period of 103 inpatients, died between 01. 10. 2001. and 31. 03. 2002. Comparing these data with those of American, Finnish etc. authors, the treatments seem to be more generous - probably because in Hungary it is not (yet?) usual to ”declare” endof- life care and to withdraw active therapy. However, indication of antibiotics seems to be more clinical (28.1%, vs. 42%-88% given by similar foreign data). Antibiotics are not palliative means, however, they may be administered in the last days, if the patient is suffering from a terminal infection. Indications and choice of antibiotics are suggested in these cases; medical and ethical problems discussed. Physicians can relieve the physical and mental distressing symptoms of the dying patient and ensure human dignity and peace of the last days.]

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[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

DELI Gabriella, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ASCHERMANN Zsuzsanna, NAGY Ferenc, BOSNYÁK Edit, KOVÁCS Norbert

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

Journal of Nursing Theory and Practice

[Quality of Life of Cancer Patients’]

PATÓ Edit

[Aim of the study: This research is the part of an extended examination. It’s aim is to assess the cancer patients’ quality of life, how the diseas effects in the way of life, and also the psychologycal burden of the patients. Furthermore to assess the patient’s knowledge of their desease. Material and Methods: The research is descriptive, empirical, supplemenary, which in nurses and patients in oncology departments of Hondvéd Hospital in Budapest and Bács-Kiskun County Hospital in Kecskemét were attend. The method of the survey was an individual questionnaire. The evaulation of the results made with MS Excel and SPSS. The complete evaluable questionnaire’s rate is 74,9% (N=131). Results: the patients judge their own health and quality of life to low in a rate of 56,6%, and 75% of them stated that their way of life and their daily routin has changed in a significant extent. 50% of the responders described their actual emotional condition with a negative indicative, and also occur different psychic disfunctions amuong them. For example the depression in a rate of 17,5%, anxiety is in 18,5%, and reduced self-evaluation in 14,1%. A significant majority (76,3%) of respondents don’t possess the appropriate knowledge. Conclusions: The disease effect on cancer patients’ way of life and quality of life in a significant way. Patients are exposed to a significant psycholigycal burden. ]

Lege Artis Medicinae

[ASSESSMENT OF THE QUALITY OF LIFE AND THE ATTITUDES TO AGEING OF ELDERLY PEOPLE]

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[BACKGROUND - The WHOQOL-OLD questionnaire was developed in a multicultural way. The authors were involved in this work as members of the international task force. In order to improve services for the elderly by learning their attitudes to ageing, an Attitudes to Ageing Questionnaire (AAQ) was also developed by the working group. In the present study the authors assessed a sample of Hungarian elderly people by these two methods. Answers by elderly persons related to their quality of life, social and health conditions, as well as their attitude to ageing were analysed. PERSONS AND METHOD - A total of 333 (190 unhealthy and 143 healthy) persons over sixty years of age filled in the questionnaires either by themselves or through verbal interview. The participants’ compliance with the research was generally good. The study sample reflected the general features of the Hungarian elderly population. For statistical analysis the Microsoft SPSS for Windows version 11.0 programme was used. RESULTS - Better health condition, better mood, and a better ability for self-care improve the quality of life. Better attitudes to ageing are associated with better quality of life. CONCLUSIONS - The use of the WHOQOLOLD questionnaire is recommended in the daily practice to assess elderly Hungarians’ quality of life. The results highlight the significance of mental health in the development of the elderly persons’ attitude to ageing. The use of the new questionnaires may help change negative stereotypes related to ageing.]

Clinical Neuroscience

[Examining the psychometric properties of a new quality of life questionnaire in migraineurs]

MANHALTER Nóra, PALÁSTI Ágnes, BOZSIK György, ÁFRA Judit, ERTSEY Csaba

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Clinical Neuroscience

Quality of life of patients with non-diabetic peripheral neuropathic pain; results from a cross-sectional survey in general practices in Hungary

BRODSZKY Valentin, PÉNTEK Márta, KOMOLY Sámuel, BERECZKI Dániel, EMBEY-ISZTIN Dezső, TORZSA Péter, GULÁCSI László

Background and purpose - There is a lack of data on the impact on health related quality of life of peripheral neuropathic pain in Hungary. The main aims of the study were to assess the health related quality of life of nondiabetic PeNP patients identified in general practices through screening, and to assess the relationship between condition specific pain scores and health state utilities. Methods - Non-diabetic patients aged ≥30 years were recruited in 10 general practices in Hungary. At first, patients filled in the PainDETECT Questionnaire (PD-Q) and those who have achieved ≥13 PD-Q score (unclear or possible neuropathic pain) were further assessed by the DN4 questionnaire. Patients with PD-Q score >18 or DN4 score ≥4 were considered to have PeNP and they completed the EQ-5D health questionnaire. Results - Among the 111 patients identified as non-diabetic PeNP patients the mean age was 62 (SD=14) years, 69% were women. Average EQ-5D score was 44% lower than the gender and age matched Hungarian norm (0.42 vs. 0.75, p<0.001) and it worsened with increasing pain intensity. The pain/discomfort and anxiety/depression were the most affected EQ-5D dimensions. Strong relationship was demonstrated between the PD-Q and EQ- 5D score. Most of the PeNP patients (86%) were undiagnosed. Conclusions - Non-diabetic PeNP pain has a huge negative impact on health related quality of life. Although PeNP is a serious chronic condition, the disease burden is seriously underestimated, both on the level of individuals and society, due to the fact that patients are rarely identified.