The research palliative care unit

  • Eduardo Bruera
  • Jose Pereira
Part of the Cancer Treatment and Research book series (CTAR, volume 100)


Approximately 50% of cancer patients die of their illness, and the overall incidence of cancer is increasing both in developed and in developing countries [1,2]. In addition, AIDS is a major cause of death among younger individuals [3].


Palliative Care Cancer Pain Palliative Medicine Palliative Care Unit Palliative Care Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    World Health Organization. 1990. Cancer pain relief and palliative care. Report of a WHO Expert Committee. Geneva: World Health Organization.Google Scholar
  2. 2.
    Scott J, and the Committee. 1991 Canada Cancer 2000: report by the expert panel on Palliative Care. Canadian Cancer Society.Google Scholar
  3. 3.
    Centers for Disease Control. 1990. Estimates of HIV prevalence and projected AIDS cases. MMWR 39:110.Google Scholar
  4. 4.
    Connors AF, Dawson NV, Desbiens NA, et al. 1995. A conrolled trial to improve care for seriously ill hospitalized patients. JAMA 274(20):1591–1598.CrossRefGoogle Scholar
  5. 5.
    Rogers EM (ed). 1983. Diffusion of Innovations, 3rd ed. New York: New York Free Press, Collier Macmillan.Google Scholar
  6. 6.
    Miller RD (ed). 1994. Anesthesia, 4th ed., vol. 2. New York: Churchill Livingstone.Google Scholar
  7. 7.
    Rippe JM, Irwin RS, Alpert JS, Fink MP (eds). 1991 Intensive Care Medicine, 2nd ed. Boston: Little, Brown.Google Scholar
  8. 8.
    Tintinalli JE (ed). 1992. Emergency Medicine, A Comprehensive Study Guide. American College of Emergency Physicians. New York: McGraw-Hill.Google Scholar
  9. 9.
    Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, et al. 1994. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 331(22): 1528.Google Scholar
  10. 10.
    Twycross RG, Fairfield S. 1982. Pain in far advanced cancer. Pain 14:303.PubMedCrossRefGoogle Scholar
  11. 11.
    Portenoy RK, Kanner RM. 1985. Patterns of analgesic prescription and consumption in a university-affiliated community hospital. Arch Intern Med 145:439.PubMedCrossRefGoogle Scholar
  12. 12.
    Twycross RG. 1980. Hospice care — redressing the balance in medicine. J R Soc Med 73:475–481PubMedGoogle Scholar
  13. 13.
    Liegner LM. 1975. St. Christopher’s Hospice, 1974. Care of the dying patient. JAMA 234(10):1047–1048.PubMedCrossRefGoogle Scholar
  14. 14.
    Mount BM. 1976. The problem of caring for the dying in a general hospital; the palliative care unit as a possible solution. Can Med Assoc J 115(2):119–121PubMedGoogle Scholar
  15. 15.
    MacDonald N, and the Canadian Committee on Palliative Care Education. 1991 The Canadian Palliative Care Curriculum.Google Scholar
  16. 16.
    Fraser J. 1995. Sharing the challenge: the integration of cancer and AIDS. J Palliat Care 11(2):23–25.PubMedGoogle Scholar
  17. 17.
    Goldstone I. 1992. Trends in hospital utilization in AIDS care 1987-1991: implications for palliative care. J Palliat Care 8(4):22–29.PubMedGoogle Scholar
  18. 18.
    Alberta Provincial Working Group. 1990. A Report Submitted by the Alberta Provincial Working Group to the Cancer 2000 Task Force, Edmonton, AB, November.Google Scholar
  19. 19.
    Bruera E. 1993. Research in symptoms other than pain. In Doyle D, Hanks G, MacDonald N (eds), Textbook of Palliative Medicine, 3rd ed., vol. 3. London: Oxford Medical Publications, 87–92.Google Scholar
  20. 20.
    Bruera E, Kuehn N, Emery B, Macmillan K, Hanson J. 1990. Social and demographic characteristics of patients admitted to a palliative care unit. J Palliat Care 6(4): 16–20.PubMedGoogle Scholar
  21. 21.
    Lichter I, Hunt E. 1990. The last 48 hours of life. J Palliat Care 6(4):7–15.PubMedGoogle Scholar
  22. 22.
    Ventafridda V, Ripamonti C, De Conno F, Tamburini M, Cassileth BR. 1990. Symptom prevalence and control during cancer patients last days of life. J Palliat Care 6(3):7–11PubMedGoogle Scholar
  23. 23.
    Doyle D. 1983. Symptom relief in terminal illness. Med Pract 1:694–698.Google Scholar
  24. 24.
    McGuire DB. 1992. Comprehensive and multidimensional assessment and measurement of pain. J Pain Symptom Manage 7(2):312–319.PubMedCrossRefGoogle Scholar
  25. 25.
    Ahles TA, Blanchard EB, Ruckdeschel JC. 1983. The multidimensional nature of cancer-related pain. Pain 17:277–288.PubMedCrossRefGoogle Scholar
  26. 26.
    Banning A, Stugren P, Henricksen H. 1991 Treatment outcome in a multidisciplinary cancer pain clinic. Pain 47:129–134.PubMedCrossRefGoogle Scholar
  27. 27.
    Fields HL, Basbaum AI. 1994. Central nervous system mechanisms of pain modulation. In Wall PD, Melzak R (eds), Textbook of Pain, 3rd ed., vol. 12. London: Churchill Livingstone 243–257.Google Scholar
  28. 28.
    Bruera E. 1994. New developments in the assessment of pain in cancer patients. Support Care Cancer 2:312–318.PubMedCrossRefGoogle Scholar
  29. 29.
    Coyle N, Breitbart W, Weaver S, Portenoy R. 1994. Delirium as a contributing factor to ‘crescendo’ pain: three case reports. J Pain Symptom Manage 9(l):44–47.PubMedCrossRefGoogle Scholar
  30. 30.
    Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. 1991 The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7(2):6–9.PubMedGoogle Scholar
  31. 31.
    Kaasa T, Coomis J, Gillis K, Bruerae, Hanson J. 1997. The Edmonton Functional Tool: Preliminary Development and Evaluation for Use in Palliative Care. J. Pain Sympt. Manage 13(l):10–19.CrossRefGoogle Scholar
  32. 32.
    Bruera E, Schoeller T, Wenk R, MacEachern T, Marcelino S, Suarez-Almazor M, Hanson J. 1995. A prospective multi-center assessment of the Edmonton Staging System for cancer pain. J Pain Symptom Manage 10(5):348–355.PubMedCrossRefGoogle Scholar
  33. 33.
    Folstein MF, Folstein S, McHugh PR. 1975. ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. J Psych Res 12:189–198.CrossRefGoogle Scholar
  34. 34.
    Ewing JA. 1984. Detecting alcoholism. The CAGE Questionnaire. JAMA 252:1905–1907.PubMedCrossRefGoogle Scholar
  35. 35.
    Bruera E, MacDonald S. 1993. Audit Methods: The Edmonton Symptom Assessment System. In Higginson I (ed), Clinical Audit in Palliative Care. Oxford: Radcliffe Medical Press 61–77.Google Scholar
  36. 36.
    Cella DF, Tulsky DS. 1990. Measuring quality of life today: methodological aspects. Oncology 4:29–38.PubMedGoogle Scholar
  37. 37.
    Mor V, Laliberte L, Morris JN, et al. 1984. The Karnofsky performance status scale. An examination of its reliability and validity in a research setting. Cancer 53:2002–2007.PubMedCrossRefGoogle Scholar
  38. 38.
    Massie MJ, Holland J, Glass E. 1983. Delirium in terminally ill cancer patients. Am J Psychiat 140(8):1048–1050.PubMedGoogle Scholar
  39. 39.
    Bruera E, Miller L, McCallion J, Macmillan K, Krefting L, Hanson J. 1992. Cognitive failure in patients with terminal cancer: a prospective study. J Pain Symptom Manage 7(4):192–195.PubMedCrossRefGoogle Scholar
  40. 40.
    Pereira J, Hanson J, Bruera E. 1997. The Frequency and Clinical Course of Cognitive Impairment in Patients with Terminal Cancer. Cancer 79(4):835–842.PubMedCrossRefGoogle Scholar
  41. 41.
    Francis J, Martin D, Kapor WN. 1990. A prospective study of delirium in hospitalized elderly. JAMA 263(8):1097–1101PubMedCrossRefGoogle Scholar
  42. 42.
    Folstein M, Fetting J, Labo A, et al. 1984. Cognitive assessment of cancer patients. Cancer 53(Suppl 10):2250–2257.PubMedGoogle Scholar
  43. 43.
    Smith M, Breitbart W, Platt M. 1995. A critique of instruments and methods to detect, diagnose, and rate delirium. J Pain Symptom Manage 10(1):35–77.PubMedCrossRefGoogle Scholar
  44. 44.
    Moore R, Bone L, Geller G, et al. 1989. Prevalence, detection and treatment of alcoholism in hospitalized patients. JAMA 261:403–407.PubMedCrossRefGoogle Scholar
  45. 45.
    Stimmel B. 1985. Pain, analgesia, and addiction: an approach to the pharmacologic management of pain. Clin J Pain 1:14–22.CrossRefGoogle Scholar
  46. 46.
    Portenoy RK. 1987. Constipation in the cancer patient: causes and management. Med Clin North Am 71:303–311PubMedGoogle Scholar
  47. 47.
    Sykes NP. 1993. Constipation and diarrhoea. In Doyle D, Hanks GWC, MacDonald N (eds), Oxford Textbook of Palliative Medicine, 4th ed., vol. 3. Oxford: Oxford University Press, 299–310.Google Scholar
  48. 48.
    Glare P, Lickiss N. 1992. Unrecognized constipation in patients with advanced cancer. A recipe for therapeutic diaster. J Pain Symptom Manage 7:369–371PubMedCrossRefGoogle Scholar
  49. 49.
    Bruera E, Suarez-Almazor M, Velasco A, Bertolino M, MacDonald SM, Hanson J. 1994. The assessment of constipation in terminal cancer patients admitted to a palliative care unit: a retrospective review. J Pain Symptom Manage 9(8):515–519.PubMedCrossRefGoogle Scholar
  50. 50.
    Beehrs OH et al. (eds). 1992. Manual for Staging of Cancer, 4th ed. Philadelphia: JP Lippincott.Google Scholar
  51. 51.
    Valagussa P, Bonadonna G, Veronesi V. 1978. Patterns of relapse and survival following radical mastectomy. Cancer 41:1170–1178.PubMedCrossRefGoogle Scholar
  52. 52.
    Rowland J. 1989. Intrapersonal resources: coping. In Holland J, Rowland J (eds), Handbook of Psycho Oncology: Psychological Care of the Patient. New York: Oxford University Press.Google Scholar
  53. 53.
    Emery B, Bruera E. 1990. Patterns of patient-family/staff conflict in a palliative care unit: a two year analysis. 8th International Congress on Care of the Terminally 111, Montreal, Oct. 1 J Palliat Care 6(3):53.Google Scholar
  54. 54.
    Fainsinger RL, MacEachern T, Miller MJ, Bruera E, Spachynski K, Kuehn N, Hanson J. 1994. The use of hypodermoclysis (HDC) for rehydration in terminally ill cancer patients. J Pain Symptom Manage 9(5):298–302.PubMedCrossRefGoogle Scholar
  55. 55.
    Bruera E, Schoeller T, Pruvost M. 1994. Letters to the Editor: Proctoclysis for hydration of terminal cancer patients. Lancet 344:1699.PubMedCrossRefGoogle Scholar
  56. 56.
    Bruera E, Watanabe S, Fainsinger RL, Spachynski K, Suarez-Almazor M, Inturrisi C. 1995. Custom-made capsules and suppositories of methadone for patients on high dose opioids for cancer pain. Pain 62:141–146.PubMedCrossRefGoogle Scholar
  57. 57.
    Fainsinger R, Bruera E. 1992. Palliative Care Round: Treatment of delirium in a terminally ill patient. J Pain Symptom Manage 7(l):54–56.PubMedCrossRefGoogle Scholar
  58. 58.
    Bruera E, Brenneis C, MacDonald RN, Michaud M. 1987. Continuous sc infusion of meto-clopramide for treatment of narcotic bowel syndrome. Cancer Treat Rep 71(11):1121–1122.PubMedGoogle Scholar
  59. 59.
    Bruera E, Macmillan K, Pither J, MacDonald RN. 1990. The effects of morphine on the dyspnea of terminal cancer patients. J Pain Symptom Manage 5(6):341–344.PubMedCrossRefGoogle Scholar
  60. 60.
    de Stoutz ND, Bruera E, Suarez-Almazor M. 1995. Opioid rotation (OR) for toxicity reduction in terminal cancer patients. J Pain Symptom Manage 10(5):378–384.PubMedCrossRefGoogle Scholar
  61. 61.
    Bruera E. 1992. WHO News. Palliative care programmes in Latin America. Palliat Med 6:182–184.CrossRefGoogle Scholar
  62. 62.
    Stjernsward J, Bruera E, Joranson D, et al. 1995. Opioid availability in Latin America: the Declaration of Florianopolis. J Pain Symptom Manage 10(3):233–236.PubMedCrossRefGoogle Scholar
  63. 63.
    Coyle N, Adelhardt J, Foley K, Portenoy R. 1990. Character of terminal illness in the advanced cancer patient: pain and other symptoms during the last 4 weeks of life. J Pain Symptom Manage 5:83–93.PubMedCrossRefGoogle Scholar
  64. 64.
    Ventafridda V, Ripamonti C, De Conno F, Tamburini M, Cassileth BR. 1990. Symptom prevalence and control during cancer patients’ last days of life. J Palliat Care 6(3):7–11PubMedGoogle Scholar
  65. 65.
    Ferrell BR, Ferrell BA, Rhines M, Grant M. 1991 Family factors influencing cancer pain management. Postgrad J Med 67(Suppl 2):564–569.Google Scholar
  66. 66.
    Bruera E, Macmillan K, Hanson J, Kuehn N, MacDonald RN. 1990. A controlled trial of megestrol acetate on appetite, caloric intake, nutritional status, and other symptoms in patients with advanced cancer. Cancer 66:1279–1282.PubMedCrossRefGoogle Scholar
  67. 67.
    Bruera E, Fainsinger R, Spachynski K, Babul N, Harsanyi Z, Darke AC. 1995. Clinical efficacy and safety of a novel controlled release morphine suppository and subcutaneous morphine in cancer pain: a randomized evaluation. J Clin Oncol 13(6):1520–1527.PubMedGoogle Scholar
  68. 68.
    Anonymous. 1964. Human experimentation: code of ethics of the World Medical Association. Br Med J 2:177.CrossRefGoogle Scholar
  69. 69.
    Royal College of Physicians. 1990. Royal College of Physicians guidelines on the practice of ethics committees in medical research involving human subjects, 2nd ed. London: Royal College of Physicians.Google Scholar
  70. 70.
    Bruera E, Spachynski K, MacEachern T, Hanson J. 1993. Letter to the Editor: Cognitive failure in cancer patients who agree to participate in clinical trials. Lancet 341:247.PubMedCrossRefGoogle Scholar
  71. 71.
    Bruera E. 1994. Ethical issues in palliative care research. J Palliat Care 10(3):7–9.PubMedGoogle Scholar
  72. 72.
    Bruera E, Miller MJ, Kuehn N, MacEachern T, Hanson J. 1992. Estimation of survival of patients admitted to a palliative care unit: a prospective study. J Pain Symptom Manage 7(2):82–86.PubMedCrossRefGoogle Scholar
  73. 73.
    den Daas N. 1995. Estimating length of survival in end-stage cancer: a review of the literature. J Pain Symptom Manage 10(7):548–555.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Eduardo Bruera
  • Jose Pereira

There are no affiliations available

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