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Background: Divergent opinions exist on what is correct and morally acceptable when it comes to the management of patients who are terminally ill and unable to maintain their own nutritional and hydration needs. This issue becomes even more problematic when it concerns patients for whom palliative sedation is considered. The aim of this study is to describe the evolution of oral and artificial food and fluid intake of patients residing in Flemish palliative care units and the possible effect of palliative sedation. Methods: A prospective longitudinal and descriptive design was used. Each patient admitted in one of the eight participating units was included if they met the inclusion criteria and gave written informed consent. Results: Two hundred and sixty-six patients were included. The incidence of palliative sedation was 7.5%.The oral food and fluid intake of these patients decreased during their stay and was reduced to a minimum a few days before death. With regard to the artificial food/fluid intake, this study reveals that only 28% of patients received artificial food and/or fluid. Moreover, it shows that the withdrawal is not a standard policy but is always based on a profound and individual decision-making process. An effect of initiating palliative sedation on the fluid intake is found, but is of no clinical relevance, in the sense that it would shorten the life of the patient. Conclusions: This longitudinal prospective study does not support the argument that palliative sedation amounts to 'slow euthanasia' because it entails the withholding or withdrawing of substantial amounts of food and or fluids, thus having a clear life-shortening effect. This study shows that palliative sedation, in specialized palliative care units, is not slow euthanasia but advanced symptom control during the final days of terminally ill patients' lives who are confronted with refractory suffering. [ABSTRACT FROM AUTHOR]

Many head and neck cancer (HNC) patients experience painful therapy-related mucositis and dermatitis. This prospective observational study evaluated transdermal buprenorphine use in HNC patients to relieve treatment-related pain. During treatment with paracetamol or tramadol, visual analogue scale (VAS)-pain scores >30/100 occurred in 26/45 patients 4 weeks after starting cancer therapy, persisting for ≥2 weeks after treatment. These patients subsequently received transdermal buprenorphine. Pain therapy should be more accurately up-titrated to the maximum recommended dose (140 μg/hr) where necessary to maintain pain scores ≤30/100 and, for some patients, should be continued for 6 weeks after the last cancer treatment day. [ABSTRACT FROM AUTHOR]

Dose-dense temozolomide schedules deplete O6-methylguanine methyltransferase and may overcome chemoresistance. This multicenter cohort study enrolled 19 patients (15 anaplastic astrocytoma, 4 anaplastic oligoastrocytoma) who received temozolomide (100 mg/m2/day for 21 consecutive days every 28-day cycle) at first recurrence, either until disease progression or 12 cycles. Six-month progression-free survival was 56%, comparing favorably with historic controls treated with the standard 5-day temozolomide schedule. Median survival was 12.9 months (95% CI: 3.7, 22 months). Among 15 evaluable patients, 2 had a complete or partial response, and 10 had stable disease. Grade 3 and 4 lymphopenia occurred in 53% and 47% of patients, respectively. [ABSTRACT FROM AUTHOR]