Management of Nosocomial Respiratory Tract Infections in Terminally Ill Cancer Patients

Green, Kerryn; Webster, Heidi; Watanabe, Sharon; Fainsinger, Robin L.

doi:10.1177/082585979401000407

Cited by 14 publications

(13 citation statements)

References 9 publications

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“…19 In end of life decision making it should also be remembered, however, that infection is a common cause of death in cancer patients, often perceived as a natural part of the dying process. 20 In accord with earlier findings 7 21 intravenous hydration was here an option very seldom withdrawn. This may be explained by the notion common among doctors that giving fluid relieves thirst and thus reduces suffering.…”

Section: General Findingssupporting

confidence: 76%

Factors affecting physicians' decisions to forgo life-sustaining treatments in terminal care

Hinkka¹

2002

J Med Ethics

154

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Objectives: Treatment decisions in ethically complex situations are known to depend on a physician's personal characteristics and medical experience. We sought to study variability in decisions to withdraw or withhold specific life-supporting treatments in terminal care and to evaluate the association between decisions and such background factors.Design: Readiness to withdraw or withhold treatment options was studied using a terminal cancer patient scenario with alternatives. Physicians were asked about their attitudes, life values, experience, and training; sociodemographic data were also collected.Setting: Finnish physicians, postal survey.Survey sample: Five hundred general practitioners, 300 surgeons, 300 internists, and 82 oncologists.Results: Treatments most often forgone were blood transfusion (82%) and thrombosis prophylaxis (81%). Least willingly abandoned were intravenous (IV) hydration (29%) and supplementary oxygen (13%). Female doctors were less likely to discontinue thrombosis prophylaxis (p=0.022) and supplementary oxygen (p<0.001), but more readilyxray (p=0.039) and laboratory (p=0.057) examinations. Young doctors were more likely to continue antibiotics (p=0.025), thrombosis prophylaxis (p=0.006), supplementary oxygen (p=0.004) and laboratory tests (p=0.041). Oncologists comprised the specialty most ready to forgo all studied treatments except antibiotics and blood transfusion. The family's wishes (alternative 1) significantly increased treatment activity. Young and female practitioners and oncologists were most influenced by family appeal. Advance directives (alternative 2) made decisions significantly more reserved and uniform. Different factors in the physician's background were found to predict decisions to withdraw antibiotics or IV hydration.Conclusion: The considerable variation observed in doctors' decisions to forgo specific life-sustaining treatments (LST) was seen to depend on their personal background factors. Experience, supervision, and postgraduate education seemed to be associated with more reserved treatment decisions. To increase the objectivity of end of life decisions, training, and research are of prime significance in this ethically complex area of medicine.

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Section: General Findingssupporting

confidence: 76%

Factors affecting physicians' decisions to forgo life-sustaining treatments in terminal care

Hinkka¹

2002

J Med Ethics

154

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“…Even though the frequency of infection in these patients is high, the frequencies reported vary widely, ranging from 16.7% to 55% (Green et al . 1994; Pereira et al .…”

Section: Discussionmentioning

confidence: 99%

Antibiotic use during the last days of life in cancer patients

Kim

et al. 2006

Eur J Cancer Care

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The purpose of this study is to document infection and to better understand current practice relating to antibiotic use and its effect in terminal cancer patients. We retrospectively reviewed patients with terminal stage cancer who were admitted to Seoul National University Boramae Hospital for symptom control only, and who finally died between March 2003 and April 2004. A total of 141 patients were enrolled. Mean duration from admission to death was 31.2 days. A total of 104 patients (75.2%) experienced a febrile episode, and physicians considered 113 patients (80.1%) developed a clinical infection. Total 119 patients (84.4%) received antibiotics. For 90 patients (63.8%), antibiotics were used until the day of death. After using antibiotics, 48% of fevers were controlled, and 31% of organism-proven cases were resolved. Symptomatic improvement of infection was achieved in 18 patients (15.1%), but 66 patients (55.4%) showed no improvement. Improved leucocytosis was achieved by 17% and C Reactive Protein elevation by 29%. In conclusion, our study reveals a high rate of infection and a high rate of antibiotic prescription during the last month of life in cancer patients. But symptomatic improvement was not achieved in more than half of the patients. Further study should be undertaken to clarify the benefit of antibiotics in terminal stage cancer patients.

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“…In cancer patients, among all the possible causes of bleeding the following should be evaluated: (1) the presence of thrombocytopenia or abnormal platelet function, which may be secondary to neoplastic bone marrow infiltration, sepsis, disseminated intravascular coagulation (DIC), idiopathic thrombocytopenia [117,118]; (2) the deficiencies in vitamin K-related coagulation factors owing to neoplastic spread in the liver; (3) the types of 208 disease, the autonomy of the patients, the life expectancy, the presence of other distressing and/or difficult symptoms and the wishes of the patient and his/her family [87].…”

Section: Infectionsmentioning

confidence: 99%

Respiratory problems in advanced cancer

Ripamonti¹,

Fusco²

2002

Support Care Cancer

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Respiratory problems are an important issue in the palliative care setting, not only from a diagnostic and therapeutic point of view but also from emotion-related aspects involving both the patients and their families and also caregivers. In this paper we consider some of the most common respiratory problems, such as dyspnea, infections, hemoptysis, hiccup. A review of the literature was performed with reference to the frequency, diagnosis and management of the above respiratory problems in patients in advanced and terminal stages of the disease. Particular emphasis was given to the importance of communication with the patients and their families, which is considered a crucial point in the care and the cure of such patients.

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Management of Nosocomial Respiratory Tract Infections in Terminally Ill Cancer Patients

Cited by 14 publications

References 9 publications

Factors affecting physicians' decisions to forgo life-sustaining treatments in terminal care

Factors affecting physicians' decisions to forgo life-sustaining treatments in terminal care

Antibiotic use during the last days of life in cancer patients

Respiratory problems in advanced cancer

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