Religious And Spiritual Beliefs
Awareness of the importance of religious beliefs and spiritual concerns within medical care has increased substantially over the last decade. National consensus guidelines, published in 2018, recommended the following:
- That all patients receive a screening assessment for religious and spiritual concerns, followed by a more complete spiritual history.
- That all patients receive a formal assessment by a certified chaplain.
- That such information is placed in patient records, with follow-up at all appropriate times, including hospitalization at the EOL.
An interprofessional approach is recommended: medical personnel, including physicians, nurses, and other professionals such as social workers and psychologists, are trained to address these issues and link with chaplains, as available, to evaluate and engage patients. A survey of nurses and physicians revealed that most nurses and physicians desire to provide spiritual care, which was defined as care that supports a patients spiritual health. The more commonly cited barriers associated with the estimated amount of spiritual care provided to patients included inadequate training and the belief that providing spiritual care is not part of the medical professionals role. Most nurses desired training in spiritual care fewer physicians did.
Challenges To The Professional Caregiver
Oncologists and nurses caring for terminally ill cancer patients are at risk of suffering personally, owing to the clinical intensity and chronic loss inherent in their work. Lack of training in advance care planning and communication can leave oncologists vulnerable to burnout, depression, and professional dissatisfaction. One group of investigators studied oncologists grief related to patient death and found strong impact in both the personal and professional realms. Negative effects included a sense of distraction and withdrawal from patients.
One study made an important conceptual distinction, explaining that while grief is healthy for oncologists, stress and burnout can be counterproductive. Other terms used to describe professional suffering are moral distress, emotional exhaustion, and depersonalization. Moral distress was measured in a descriptive pilot study involving 29 physicians and 196 nurses caring for dying patients in intensive care units. Both groups of professionals experienced moral distress related to pressure to continue aggressive treatment they considered futile. Nurses experienced more moral distress than did physicians, and perceived less collaboration than did their physician colleagues.
References
Andrews Final Week At Home
It was a very busy and happy house in the final week. Friends and family visited every morning and evening. Andrew and I rested in between.
It was a very busy and happy house in the final week.
Andrew was paralysed from his spinal cord compression, so his needs were quite complicated. We had carers come in four times a day to clean and move Andrew. And every afternoon, the district nurses would come in. They would check on Andrew and see how he was doing. And they would sit and talk to me and see how I was.
The district nurses left a box of drugs in our house. They explained to us that they would give Andrew these drugs if his current drugs werent able to control his pain. It made me realise that he would actually die soon. But it also reassured me that the nurses were prepared and knew what they were doing.
Andrew turned to me one day and said, Im not frightened of dying, I just dont want to leave you.
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Gleason Prostate Cancer Score
1960s as a way to measure how aggressive your prostate cancer may be.
A pathologist determines your Gleason score by looking at a biopsy of your prostate tissue under a microscope. They grade the cells in the biopsy on a scale of 1 to 5. Grade 1 cells are healthy prostate, whereas grade 5 cells are highly mutated and dont resemble healthy cells at all.
The pathologist will calculate your Gleason score by adding together the number of the most prevalent type of cell in the sample and the second most prevalent type of cell.
For example, if the most common cell grade in your sample is 4 and the second most common is 4, you would have a score of 8.
A Gleason score of 6 is considered low-grade cancer, 7 is intermediate, and 8 to 10 is high-grade cancer.
Ontogenesis Of Postural And Sphincter Anticipatory Adjustments
The control of body position in space develops with different intensity during life span . As an example, Zaino and McCoy showed that young healthy children exhibit much higher variability of posture control than older healthy children . It is also reported that the age 79 years is an important period of their life in which children master postural control . Moreover, Schmitz et al. showed that children 34 years old develop APA, although they show coexistence of both adult-like and immature patterns, concluding that this anticipatory activities are being set up and that children are progressively mastering them.
Changes in brain structure are continuous throughout life . By the age 2, the brain has reached 75% of its adult weight and the processes of synaptic pruning and cell death are most active during these early years . During the school-age years, strong signs of brain maturation are appreciable, especially in its connectivity . MRI measures of the structure in fibers tracts correlate with behavioral indices that also change in this period . Later changes involve the associative neocortex, which continues to develop well into the third decade , and the corpus callosum, which connects all major subdivisions of the cerebrum .
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First Line Treatment For Advanced Prostate Cancer
The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.
There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.
Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.
Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.
Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.
How Do I Know How Long I Have Left To Live
You might want to know how long you have left to live. This can help you prepare and plan the time you have left. There might be things you want to do or people you want to see. But some men dont want to know how long they have left. Everyone is different.
You can ask your doctor how long you have left to live. They wont be able to give you an exact answer. This can be frustrating and it may feel like your doctor is trying to avoid your questions. But no-one can know for certain how long you have left because everyone’s body and everyone’s cancer is different. However, your doctor will be able to give you some idea based on where the cancer has spread to, how you are responding to treatment, how quickly the cancer has spread, and what problems it is causing.
It can be helpful to talk with your family about this. You may not want to upset them but they might have similar questions and thoughts to you.
If you have months or maybe years left to live, it can be difficult for your doctor to say exactly how long you have left. This is because they dont know how you will respond to different treatments. If your treatment stops working so well, there may be other treatments available. Some men may not respond well to one treatment, but may respond better to another. Read more about treatments for advanced prostate cancer.
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Treatment Options For Localized Prostate Cancer
If you are diagnosed with low-risk prostate cancer, you may be presented with a number of different treatment options. The most common include:
- Active Surveillance: Your healthcare provider may want to monitor your disease to see if treatment is necessary. With active surveillance, you will have regular check-ups with your healthcare providers, and he or she may perform biopsies regularly. If your test results change, your healthcare provider will discuss your options for starting treatment.
- Watchful Waiting: While some healthcare providers use the terms active surveillance and watchful waiting interchangeably, watchful waiting usually means that fewer tests are done. You will still visit your healthcare provider regularly, but your healthcare provider will discuss changes in your health as they relate to managing your symptoms, not curing your disease.
- Prostatectomy: Removal of the prostate, called prostatectomy, is an option that has a strong likelihood of removing your cancer since you are removing the gland where it is located. However, this is an invasive procedure that can lead to other issues, which will be covered later.
- Radiation: Your healthcare provider may suggest radiation as a means of therapy that targets tumors with radiation, usually through daily treatments in a hospital or clinic over multiple weeks.
What Are Prostate Cancer Survival Rates By Stage
Staging evaluation is essential for the planning of treatment for prostate cancer.
- A basic staging evaluation includes the patient examination, blood tests, and the prostate biopsy including ultrasound images of the prostate.
- Further testing and calculations may be performed to best estimate a patient’s prognosis and help the doctor and patient decide upon treatment options.
Prognosis refers to the likelihood that cancer can be cured by treatment, and what the patient’s life expectancy is likely to be as a consequence of having had a prostate cancer diagnosis.
If cancer is cured, your life expectancy is what it would have been had you never been diagnosed with prostate cancer. If cancer cannot be cured due to it recurring in distant locations as metastases, or recurs either locally or in an area no longer able to be treated in a curative manner, then estimates can be made of what is likely to be your survival-based again on group statistics for people who have been in the same situation.
Nomograms are charts or computer-based tools that use complex math from the analysis of many patients’ treatment results.
The prognosis for prostate cancer varies widely and depends on many factors, including the age and health of the patient, the stage of the tumor when it was diagnosed, the aggressiveness of the tumor, and cancer’s responsiveness to treatment, among other factors.
The 5 and 10-year survival rate of prostate cancer chart
| Stage and 5-Year Survival |
|---|
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Patients And Their Families May Have Cultural Or Religious Beliefs And Customs That Are Important At The Time Of Death
After the patient dies, family members and caregivers may wish to stay with the patient a while. There may be certain customs or rituals that are important to the patient and family at this time. These might include rituals for coping with death, handling the patients body, making final arrangements for the body, and honoring the death. The patient and family members should let the healthcare team know about any customs or rituals they want performed after the patients death.
Healthcare providers, hospice staff, social workers, or spiritual leaders can explain the steps that need to be taken once death has occurred, including contacting a funeral home.
See the PDQ summary on Spirituality in Cancer Care for more information.
Gleason Score Vs Grade Groups
The International Society of Urological Pathology released a revised prostate cancer grading system in 2014. The grade group system seeks to simplify Gleason scores and give a more accurate diagnosis.
One of the major problems with the Gleason score is that some scores can be made up in different ways. For example, a score of 7 can mean:
- 3 + 4. The 3 pattern is the most common in the biopsy and 4 is the second most common. This pattern is considered favorable intermediate risk.
- 4 + 3. The 4 pattern is the most common in the biopsy and 3 is the second most common. This pattern is considered unfavorable and may mean local or metastatic spread.
So, although both situations give a Gleason score of 7, they actually have very different prognoses.
Heres an overview of how the two grading systems compare:
| Cancer grade | |
|---|---|
| grade group 5 | 910 |
Not all hospitals have switched to the grade group system. Many hospitals give both grade group and Gleason scores to avoid confusion until grade groups become more widely used.
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Survival Rates By Tnm Stage
The first approach is based on the TNM stage statistical survival times are matched to the stage of the disease.
| TNM Lung Cancer Stage | |
|---|---|
| M1c | 6.3 months |
By contrast, the one-year survival rate for stage 4 lung cancer was reported in one study to be between 15% and 19%, meaning this portion of patients with metastatic disease lived for at least a year.
Possible Changes In Body Function
- Profound weakness usually the patient cant get out of bed and has trouble moving around in bed
- Needs help with nearly everything
- Less and less interest in food, often with very little food and fluid intake for days
- Trouble swallowing pills and medicines
- More drowsiness the patient may doze or sleep much of the time if pain is relieved, and may be hard to rouse or wake
- Lips may appear to droop
- Short attention span, may not be able to focus on whats happening
- Confusion about time, place, or people
- Limited ability to cooperate with caregivers
- Sudden movement of any muscle, jerking of hands, arms, legs, or face
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What Is The Outlook
No cure is available for stage 4 prostate cancer. Your healthcare team will work with you to help control the cancer for as long as possible while maintaining a good quality of life.
Your outlook will depend on how fast the cancer is spreading and how well you respond to therapies.
With treatment, you can live for many years with metastatic prostate cancer.
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How To Make The Right Treatment Decision
Current expert guidelines for treatment of localized prostate carcinoma recommend potentially curative therapy for patients whose life expectancy is at least 10 years., Patients with limited life expectancy are more likely to die from health conditions other than prostate cancer. Men with a life expectancy of more than 10 years are more likely to die from progressive prostate cancer. This 10-year rule enjoys broad acceptance among urologists and radiation oncologists.,
Conservative management proved to be an acceptable treatment option for men with low-grade Gleason scores, clinically localized disease, and life expectancies of less than 10 years. Increasing age was described as a risk factor for receiving inadequate treatment for prostate cancer. Thus, older men have been shown to receive potentially curative therapy less often than younger men., Radical prostatectomy is preferred treatment in men younger than 70 years, whereas radiation therapy is applied predominantly in patients older than 70 years. Conservative therapy such as watchful waiting or androgen deprivation by luteinizing hormone-releasing hormone analogs is preferentially applied in men older than 80 years. Watchful waiting or hormonal therapy is used to treat 82% of men older than 80 years.
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Prostate Cancer Life Expectancy
Cancer life expectancy depends on the stage of the cancer and on the treatment that the patient undergoes. Early detection of cancer and prompt treatment help increase the life expectancy of the patient. Once prostate cancer is detected, prostatectomy , radiotherapy , watchful waiting , hormone therapy, and other types of treatments are recommended by doctors.
To undergo a prostatectomy, the cancer needs to be detected in the early stages. Once the cancer metastasizes, it is difficult to remove it, or it is difficult to control its growth. So, survival rate and life expectancy for stage 4 prostate cancer cannot be favorable.
Advanced Prostate Cancer Life Expectancy And Prognosis
Typically, each stage of prostate cancer has different prognosis. In general, the advanced stages of the disease are much more difficult to treat than when the disease is still at early stage not yet spread. What are factors that affect the outlook and life expectancy of patient? The following are some statistics for each stage of this disease.
You might also like to know more about how fast prostate cancer spreads and what are the most common sites /organs of the body for the metastasis of this cancer in this section, before continuing
One thing you need to clearly understand that there is no any statistic that can be detail enough to tell you about what will happen. In other words, this statistic is only purposed for general information! In fact, each case of cancer is unique. So, there is always a chance and a hope for anyone who diagnosed with cancer.
Advanced prostate cancer symptoms
The symptoms of the disease are more likely to occur when the disease at advanced stage. This is the most challenging for doctors, because the early warning signs that are more likely to not occur will increase the number of patients diagnosed with the disease at later stages.
Once the cancerous tumor is bigger in size and also spreads to nearby sites or even other distinct organs of the body, there will be more complications that can be generated. These may include:
Understanding n-years survival statistics
The major factors that affect the outlook of patients
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