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Substance Use Disorder, Intentional Self-Harm, Gun Violence, and HIV/AIDS
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Individuals with advanced stage disease of AIDS may present with several reasons for referral for palliative care, and with a six-month prognosis, for hospice care. Some will experience AIDS-related cancers such as central nervous system (CNS) lymphoma, Kaposi’s sarcoma, and/or systemic lymphoma. Other conditions associated with advanced AIDS include: refractory cachexia; opportunistic infections (e.g. mycobacterium avium complex [MAC], cryptosporidium, cytomegalovirus, toxoplasmosis); renal failure; congestive heart failure; advanced AIDS dementia complex; and progressive multifocal leukoencephalopathy. Eligibility for hospice care for individuals with HIV/AIDS in the United States includes consideration of CD4/viral load levels, concurrently with one of the previously listed conditions associated with advanced disease.67 Additionally, a Karnofsky Performance Status of <50 also meets hospice eligibility criteria. An interdisciplinary team is needed to manage the multifaceted presentation of advanced AIDS disease. Addressing end-of-life symptoms with a holistic approach can provide for the most peaceful outcomes possible.
Refractory Cancer Cachexia
Published in Victor R. Preedy, Handbook of Nutrition and Diet in Palliative Care, 2019
Performance: A systematic review identified 135 different assessment tools (Helbostad et al. 2009). Simple and frequently used tools are the Karnofsky Performance Status (KPS) scale and ECOG, which are based on a physician's estimation. Patient-reported physical functioning is part of the EORTC-OLQ-C30. Psychosocial impact should be assessed (e.g., items such as ‘how much do you feel distressed about your inability to eat?’, ‘have you experienced feelings of pressure, guilt, or relational distress related to cachexia and weight loss?’). A single question asking about concerns regarding eating or the FAACT may be helpful for screening purposes. A validated tool, however, is lacking to date. Refractory cachexia is suggested by significant weight loss, low intake, and low performance status, and proven by unresponsiveness to anti-cachexia treatment.
Respiratory system
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
All forms of treatment can be associated with notable toxicity. Patients with significant impairment due to their lung cancer or comorbid conditions may not be fit to undergo resection or even aggressive chemoradiotherapy. Performance status can be assessed by a variety of methods including the Karnofsky Performance Status (KPS) or the World Health Organisation (WHO) status.
Does preoperative health-related quality of life predict survival in high-grade glioma patients? – a prospective study
Published in British Journal of Neurosurgery, 2020
Lisa Marie Haraldseide, Asgeir Store Jakola, Ole Solheim, Lisa Millgård Sagberg
Prognostic factors are important for clinical decision making, and several different factors have been identified in HGG patients. Some of the most significant preoperative prognostic factors are age, expected histological diagnosis, comorbidity, and tumor localization.5–8 In addition, patients functional level, often assessed by health professionals as Karnofsky Performance status (KPS), remains a strong prognostic factor in general cancer patients,9 including HGG.10–14 However, while functional status in general cancer patients is often linked to the extent or stage of the disease, this correlation is less established in brain cancer as small lesions in or near functional areas (so-called eloquent areas) may result in severe loss of functions. Another point is that clinician-rated functional status does not capture all facets of functions or health-related quality of life (HRQoL) as viewed by the patients themselves.15
Percutaneous minimally invasive thermal ablation for management of osseous metastases: recent advances
Published in International Journal of Hyperthermia, 2019
Anderanik Tomasian, Jack W. Jennings
Patient performance status is typically assessed by widely used and validated Karnofsky performance status [3]. Spinal instability is a relative contraindication for percutaneous thermal ablation depending upon severity. Spinal instability is determined using the spinal instability neoplastic score (SINS) [45]. Scores range from 0 to 18, and higher scores indicate greater instability. Although there is no score cutoff to prompt surgery, surgical evaluation for potential tumor resection and/or stabilization is recommended for scores of 7 or higher [46]. At our institutions, we treat patients with spinal instability who are not surgical candidates with vertebral augmentation, which does not entirely restore stability but relieves pain related to motion at fracture site. Surgery is the treatment of choice for spinal metastases complicated by central canal stenosis [47]; however, in the absence of spinal cord compression, thermal ablation may be considered as an alternative for patients who are not surgical candidates. CT and MR imaging are used to determine if central canal stenosis is due to tumor alone or in combination with retropulsion of fracture fragments as ablation may arrest or cause retraction of epidural tumor but will not alleviate symptoms related to osseous central canal stenosis. Such patients are alternatively managed by epidural corticosteroid and long-acting anesthetic injections [48].
A 12-week interdisciplinary rehabilitation trial in patients with gliomas – a feasibility study
Published in Disability and Rehabilitation, 2018
Anders Hansen, Karen Søgaard, Lisbeth Rosenbek Minet, Jens Ole Jarden
The study was conducted at the Neurooncology Clinic at Odense University Hospital, Denmark a clinic comprising a neurooncology team (physician, nurse, PT, OT, and neuropsychologist etc.) treating patients with brain tumors. Between 1 May 2013 and 31 March 2014 eligible patients were contacted by their treating neurooncologist ensuring inclusion criteria were met, including (i) diagnosis of glioma as defined by the world health organization (WHO grade I–IV) [4], (ii) age ≥18 (iii) Karnofsky performance status ≥70 (KPS), and (iv) ability to follow Danish instructions. Exclusion criteria were (i) pregnancy (ii) active psychiatric diagnosis or substance abuse (iii) heart problems exceeding New York Heart Association group III and IV, or (iv) global aphasia.