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Endoscopic Sinus Surgery & Sleep Dysfunction

Endoscopic Sinus Surgery & Sleep Dysfunction

Research has shown that there are important links between quality of life (QOL), sleep quality, and chronic rhinosinusitis. Studies suggest that more than 75% of patients with chronic rhinosinusitis have abnormal sleep quality, with worse sleep often being experienced in patients with more severe chronic rhinosinusitis. Higher levels of sleep dysfunction can also impact treatment decisions for patients with chronic rhinosinusitis, with their choices ranging from undergoing surgical therapy or continuing medical management. “Sleep disorders and fatigue are both common among patients with chronic rhinosinusitis,” says Timothy L. Smith, MD, MPH. “These comorbidities are thought to be, in part, related to chronic inflammation in the sinuses. In some cases, they may be the result of chronic infections. It has been suspected that blockages in the nasal passages are the primary reason for decreased sleep quality in patients with chronic sinusitis, and that sleep quality will improve after the airway obstruction is treated.” Patients with chronic rhinosinusitis and comorbid obstructive sleep apnea (OSA) have a lower QOL than others, according to clinical investigations. “Both chronic rhinosinusitis and OSA are known to have substantial adverse effects on sleep,” says Dr. Smith.   Taking a Closer Look There is evidence suggesting that functional endoscopic sinus surgery (FESS) can result in lasting improvements in chronic rhinosinusitis-specific QOL among patients with medically refractory disease. It is unclear, however, if similar improvements can be achieved in patients with chronic rhinosinusitis and comorbid OSA after FESS. For a study published in JAMA Otolaryngology—Head & Neck Surgery, Dr. Smith and colleagues sought to determine the impact of comorbid OSA on chronic rhinosinusitis disease-specific QOL and sleep dysfunction...
Enhancing QOL During Radiotherapy for Advanced Cancer

Enhancing QOL During Radiotherapy for Advanced Cancer

Cancer patients often experience a reduction in quality of life (QOL) during and after cancer treatment. Many experience pain, nausea, fatigue, sleep, and distress, among others. Family members caring for these patients often experience a lower QOL. Many studies have tested approaches to improve psychosocial functioning, but most have focused on only one aspect of psychosocial functioning. QOL is comprehensive and consists of five domains: cognitive, physical, emotional, social, and spiritual well-being. Testing a New Intervention for Patients Receiving Radiation In a study published in Cancer, my colleagues and I conducted a randomized trial in which we sought to help patients with advanced cancer receiving radiation therapy. Family members were also included in the study. While half of the participants stayed with their usual care during treatment, the other half participated in a multidisciplinary program of six, 90-minute sessions that formally addressed the five aforementioned domains of QOL. Each session included: • Physical therapy exercises to improve fatigue. • Discussions of topics like coping strategies or spiritual concerns. • Deep breathing or guided imagery to reduce stress.   Our results demonstrated that the multidisciplinary intervention was effective in maintaining the QOL of patient participants. Conversely, patients who stayed with their standard routines showed a decline in QOL measures. Much of our program’s success was attributable to active engagement from patients. They also received support and encouragement to continue to practice the coping strategies, such as physical activity, spirituality—and relaxation—when cancer treatment was completed. More to Come: Maintaining Improved QOL Our study showed that our intervention can maintain QOL during cancer treatment, but unfortunately, our follow-up conducted 6 months after...
Considerations for Dosing of Oral Therapies in Metastatic RCC

Considerations for Dosing of Oral Therapies in Metastatic RCC

For patients with meta­static renal cell carcinoma (mRCC), oral therapy has improved out­comes and has become a standard of care. When selecting oral therapies for mRCC, an important consideration is how well patients can tolerate optimal dosing of a particular agent.2 As Robert A. Figlin, MD, FACP, noted in an article published in the August 2013 issue of Physician’s Weekly—Oncology Edition, a key goal when initiating oral therapy in mRCC patients is to maintain the starting dose throughout the treatment course when possible. Outside of a clinical trial setting, the application of oral therapies may present some challenges when treating mRCC patients with unique needs.1 For example, some patients may be more prone than others to experience potential drug interactions or to have comorbidities that can affect how patients are managed with oral therapy. Prior to initiating oral therapy, clinicians should educate patients about the potential treatment-related adverse reactions (ARs). Patients should be made aware that some ARs, but not all, may be manageable during their treatment. Oral therapies have been shown to have serious life-threatening side effects, in addition to low-grade ARs.   Dosing regimens of oral therapy for mRCC might need to be adjusted based on individual safety and tolerability.1 When to Consider Dose Modifications or Interruptions Currently, there are no data that directly compare the relative safety and tolerability of oral therapies for mRCC.2 As a result, clinicians must rely on data provided from published studies of randomized controlled trials involving available agents, dosing recommendations in the package insert information, and their own clinical experience.1 In some patients, dose modifications or interruptions may be considered when managing treatment-related...
The Effects of Creative Art Therapy in Cancer

The Effects of Creative Art Therapy in Cancer

Many patients with cancer report using at least one complementary and alternative medicine (CAM) therapy. Various CAM therapies appear to improve the psychological symptoms that are commonly linked to cancer and its treatment, including disease-related fatigue, pain, and symptoms of anxiety and depression. Creative arts therapies (CATs)—which include drama therapy, writing therapy, music therapy, dance and movement therapy, and various forms of art therapy—have received less attention than other CAM therapies. Current clinical research on CATs has expanded from largely observational science to a wider, cross-disciplinary approach. Previous reviews have suggested that CATs may be useful adjuvant therapies to improve cancer- and treatment-related symptoms during and after treatment. To date, however, there has been no systematic review of randomized clinical trials (RCTs) examining the effects of CAT on psychological symptoms among cancer patients. A Comprehensive Review In JAMA Internal Medicine, my colleagues and I had a systematic review and meta-analysis published that used results from RCTs to evaluate the effect of CAT exposure on psychological symptoms and quality of life (QOL) in patients with cancer. In our review, we included 27 RCTs that involved more than 1,500 study participants. Our findings showed that CATs significantly reduced anxiety, depression, and pain and increased QOL after treatment. Pain appeared to remain significantly lower for patients using CAT when assessed at follow-up. Exposure to CAT did not appear to significantly reduce symptoms of fatigue after treatment or during follow-up, but these data are more difficult to interpret because the effects may be modality dependent. More specifically, reductions in anxiety were strongest in RCTs that had a non-CAT therapist administer the intervention as...
Improving QOL With Coronary Interventions

Improving QOL With Coronary Interventions

For more than 30 years, research has indicated that PCI decreases mortality in STEMI and reduces recurrent ischemic events in patients with non-ST elevation acute coronary syndrome. The overriding goal in performing PCI for these patients is to reduce morbidity and mortality, but quality of life (QOL) is another important aspect to consider. Studies comparing QOL after PCI versus medical therapy or CABG generally report on angina, but this is only one symptom that is relieved by coronary interventions. PCI can also enhance the ability to function, exercise, and perform activities of daily living in many patients. Some comorbidities, however, can limit QOL before and after PCI and may minimize the chances of any improvement in QOL after undergoing the procedure. Individualizing Approaches for PCI & CABG The Society of Cardiovascular Angiography and Interventions (SCAI) released a consensus statement on the effect of PCI on QOL. Published in an issue of Catheterization and Cardiovascular Interventions, the document recommends that clinicians take into consideration that improvements in QOL due to PCI vary from patient to patient. For example, patients who are severely limited by angina will have dramatic improvements in QOL if PCI relieves the angina. However, patients who are severely limited by other medical problems may not experience much improvement in QOL after PCI. Investigations comparing CABG to PCI suggest that QOL is better in the first few months after PCI. At 3 to 5 months, QOL is similar for both PCI and CABG. After 1, 3, and even 5 years, however, QOL tends to be better for patients who receive CABG. When counseling patients on treatment decisions, SCAI...
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