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BACKGROUND Refusal of appropriately indicated do-not-resuscitate (DNR) orders may cause harm and distress for patients, families, and the medical team. We conducted a retrospective study to determine the frequency and predictors of refusals of DNR in advanced cancer patients admitted to an acute palliative care unit. METHODS A total of 2538 consecutive(More)
Methylnaltrexone, a peripheral mu-opioid receptor antagonist with restricted ability to cross the blood-brain barrier, may relieve opioid-induced constipation (OIC) without reversing analgesia. A total of 154 patients with advanced illness and OIC enrolled in a double-blind, randomized, placebo-controlled trial, with optional open-label phases (up to 4(More)
CONTEXT The current state of palliative care in cancer centers is not known. OBJECTIVES To determine the availability and degree of integration of palliative care services and to compare between National Cancer Institute (NCI) and non-NCI cancer centers in the United States. DESIGN, SETTING, AND PARTICIPANTS A survey of 71 NCI-designated cancer centers(More)
PURPOSE Inpatient palliative care units are unavailable in most cancer centers and tertiary hospitals. The purpose of this article is to review the outcomes of the first 344 admissions to the Palliative Care Inpatient Service (PCIS) at our comprehensive cancer center. PATIENTS AND METHODS We retrospectively reviewed our computerized database for clinical(More)
Effective communication is the cornerstone of excellence in patient care, and breakdown in communication is a common problem leading to requests for bioethics consultation. In palliative medicine, issues involving end-of-life decisions inherently involve many potential ethical concerns. Ensuring good communication among the physician, health care(More)
This study was designed to characterize unmet analgesic needs in a group of cancer patients. One hundred one inpatients were surveyed to document pain prevalence and intensity, satisfaction with pain control and factors associated with unmet analgesic needs during the week prior to admission. Forty-four percent had unmet analgesic needs, defined as pain of(More)
Depending on their frequency and severity, hot flashes can be a major source of distress for individuals with cancer, particularly women with a history of breast cancer and men with prostate cancer. Characterized by increased skin temperature, skin conductance, and heart rate, hot flashes are associated with somatic, behavioral, and emotional(More)
PURPOSE This study compared the clinical efficacy of oxycodone hydrochloride controlled-release (CR) tablets administered every 12 hours with immediate-release (IR) oxycodone tablets administered four times daily in patients with cancer-related pain. PATIENTS AND METHODS Cancer patients who required therapy for moderate to severe pain were randomized to(More)
Clinicians have limited accuracy in the prediction of patient survival. We assessed the accuracy of probabilistic clinician prediction of survival (CPS) and temporal CPS for advanced cancer patients admitted to our acute palliative care unit, and identified factors associated with CPS accuracy. Eight physicians and 20 nurses provided their estimation of(More)