Supportive-Palliative Cancer Therapies...K ,˚ ˇˆ L$ - ’ %> ˛ & 4 ˙ 9, , 4 5 ˛ 6˚78 *+...

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Transcript of Supportive-Palliative Cancer Therapies...K ,˚ ˇˆ L$ - ’ %> ˛ & 4 ˙ 9, , 4 5 ˛ 6˚78 *+...

Page 1: Supportive-Palliative Cancer Therapies...K ,˚ ˇˆ L$ - ’ %> ˛ & 4 ˙ 9, , 4 5 ˛ 6˚78 *+ 2˘’3 N˚KjjjB z˛jjj˝ ˙ % K2 ˆ˙jjjjjjjjj˝ 6$ jjjjjj %! % 6˙ ˆ˙˝ 6Njj˛Q%
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References:

1- Swarm RA, Abernethy AP, Anghelescu DL, et al. NCCN clinical practice guideline in oncology, Adult cancer pain. Version 2.2013

2- Kral LA, Ghafoor VL. Pain and its management. In: Koda-Kimble & Young’s Applied Therapeutics, the clinical use of drugs, 10th edition, Woltres-Kluwer: Lippincott Williams & Wilkins; 2013; P: 138-146

3- Portenoy RK, Dhingra LK. Overview of cancer pain syndromes. UpToDate 2015.

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References:

1- Hesketh PJ. Prevention and treatment of chemotherapy-induced nausea and vomiting. UpToDate 2016.

2- Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med 2008; 358:2482.

3- Roila F, Herrstedt J, Aapro M, et al. Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol 2010; 21 Suppl 5:v232.

4- Basch E, Prestrud AA, Hesketh PJ, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2011; 29:4189.

5- Hesketh PJ, Bohlke K, Lyman GH, et al. Antiemetics: American Society of Clinical Oncology Focused Guideline Update. J Clin Oncol 2016; 34:381.

6- http://www.fda.gov/Drugs/DrugSafety/ucm310190.htm (Accessed on July 02, 2012).

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References:

1- Sonis ST, Elting LS, Keefe D, etal. Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology and consequences for patients. Cancer 2004;100(9 Suppl): 1995-2025.

2- Sonis ST. Pathology of oral mucositis: novel insights and opportunities. J Support Oncol 2007; 5(9 Suppl 4):3-11.

3- Barasch A, Peterson DE. Risk factors ulcerative oral mucositis in cancer patients: unanswered questions. Oral Oncol 2003; 39: 91-100.

4- Murphy BA. Clinical and economic consequences of mucositis induced by chemotherapy and/or radiation therapy. J Support Oncol 2007; 5(9 Suppl 4): 13-21.

5- Potting CM, Blijlevens NA, Donnelly JP, etal. A scoring system for the assessment of oral mucositis in daily nursing practice. Eur J Cancer Care 2006; 15: 228-234.

6- Clarkson JE, Worthington HV, Furness S, etal. Interventions for treating oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev 2010; 8: CD001973.

7- Peterson DE, Bensadoun RJ and Roilaf, ESMO Guideline Working Group. Ann Oncol 2011; (Suppl 6): vi 78-84.

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References:

1- Langstein HN, Duman H, Seelig D, et al. Retrospective study of the management of chemotherapeutic extravasation injury. Ann Plast Surg 2002; 49:369.

2- Yildizeli B, Laçin T, Batirel HF, Yüksel M. Complications and management of long-term central venous access catheters and ports. J Vasc Access 2004; 5:174.

3- La Langstein HN, Duman H, Seelig D, et al. Retrospective study of the management of chemotherapeutic extravasation injury. Ann Plast Surg 2002; 49:369.

4- Barlock AL, Howser DM, Hubbard SM. Nursing management of adriamycin extravasation. Am J Nurs 1979; 79:94.

5- Fischer D, Knobf M, Durivage H. The Cancer Chemotherapy Handbook, Mosby, 1997. p.514.

6- Schulmeister L. Extravasation management: clinical update. Semin Oncol Nurs 2011; 27:82.

7- Ajani JA, Dodd LG, Daugherty K, et al. Taxol-induced soft-tissue injury secondary to extravasation: characterization by histopathology and clinical course. J Natl Cancer Inst 1994; 86:51.

8- Saini A, Berruti A, Sperone P, et al. Recall inflammatory skin reaction after use of pegylated liposomal doxorubicin in site of previous drug extravasation. Lancet Oncol 2006; 7:186.

9- Bozkurt AK, Uzel B, Akman C, et al. Intrathoracic extravasation of antineoplastic agents: case report and systematic review. Am J Clin Oncol 2003; 26:121.

10- Larson DL. What is the appropriate management of tissue extravasation by antitumor agents? Plast Reconstr Surg 1985; 75:397.

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3A4, 41 5FU, 85, 87

5-HT3, 68, 69, 70, 71, 72, 73, 74, 75

Amifostine, 88 Buccal, 82 Butorphanol, 33, 34 Codeine, 33 Dexrazoxane, 97 Dexrazoxane, 100, 101 Disintegrating, 70 Dmso, 99, 101, 102 Dorsal, 82

End-Of-Dose Failure Pain, 32 Enteritis, 11 Extravastion, 91 Fentany, 33 G-Csf, 87 Glossopharyngeal Neuralgia, 17 Gvhd, 10 Hepatic Distention Syndrome, 14 Hydrocodone, 33 Hydromorphone, 33 Incident Pain, 32 Levorphanol, 33 Lymphedema, 22

Maois, 72 Meperidine, 33 Methadone, 33 Morphine, 33 Nalbuphine, 33, 34 Nf-Kb, 83, 84 Nk1, 72, 73, 74, 76, 77, 78 Nociceptive, 11, 14, 28 Nsaids, 24, 25, 29, 56, 57, 58 Opioid Rotation, 31 Oxycodone, 33 Oxymorphone, 33 Palliative, 30, 52 Palliative, 12 Palliative Care, 52 Pentazocine, 33 Plexopathy, 3, 7, 11, 13, 21 Plexopathy, 7 Pregabalin, 50 Proctitis, 7 Snri, 50 Ssri, 50 Ssris, 41, 72 Ulcerative, 82, 90 Ventral, 82