Anesthetic Aspects of Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy (HITHOC) in Treatment of Pleural Malignancies - Experiences from IORS
Background: Cytoreductive surgery (CRS) with hyperthermic intrathoracic chemotherapy (HITHOC) is a procedure that includes surgical removal of all visible tumor implants and intrathoracic application of gradually heated cytostatic solution. Numerous changes in hemodynamic, respiratory, core body temperature and metabolic parameters are possible during this complex procedure. The aim of this retrospective study was to analyze pathophysiological changes which occur during CRS + HITHOC procedure, and to suggest efficient strategies for perioperative patient care that might reduce complication rate.
Methods: The study included 7 patients who underwent CRS + HITHOC in our cancer center. Enhanced Recovery After Surgery (ERAS) guideline for Thoracic Surgery was applied to all patients. Data on intraoperative hemodynamics (mean arterial pressure, stroke volume, heart rate, cardiac output) and temperature variations were collected from medical records and analyzed in three timelines: during the CRS phase, at the beginning, and the end of cytostatic perfusion. Occurrence of respiratory, renal, and cardiac complications was monitored.
Results: All patients were respiratory stable during one-lung ventilation, with adequate gas exchange. Hemodynamic stability was compromised at the beginning of cytostatic perfusion, with significant decrease of mean arterial pressure and stroke volume. Two patients required vasopressor support. Average core body temperature was satisfactory in all patients. Coagulation disorders and acute renal failure were not recorded in postoperative period. One patient developed atrial fibrillation which was successfully pharmacologically restored.
Conclusion: Our results indicate that goal directed fluid management following ERAS protocol, with maintaining hemodynamic stability and normothermia, could prevent perioperative complications during HITHOC procedure.
DOI: 10.29245/2578-2967/2024/1.1204 View / Download PdfTaste Alterations: Clinicians’ Perspective on Cancer Patient Outcomes and Management Strategies
Taste alterations, a common treatment-related side effect among cancer patients, with up to 93% complaining of taste-related symptoms. Even with its high prevalence, patients report a lack in support from clinicians. Clinicians’ perspective regarding taste alterations among cancer patients is not well understood. Thus, this study examines clinicians’ perspectives regarding taste alterations among cancer patients. In an online survey, sixty-seven clinicians practicing in the United States and working with cancer patients complaining of taste problems answered questions on their experience treating patients' taste alteration symptoms.
Clinicians are most concerned about the impact of taste alterations on nutritional intake, emotional distress, and overall quality of life. 73% reported understanding the patient's taste alterations was important or very important. Yet roughly 75% thought it was challenging to recommend strategies to manage their symptoms, and nearly all reported feeling frustrated when supporting patients’ taste alterations. Regarding management strategies, clinicians mostly suggested dietary counseling, drinking plenty of fluids during meals, and changing the texture of the food, with some success reported for these strategies. This study provides new insight into clinicians’ experiences supporting cancer patients with taste alterations, helping identify knowledge gaps. A lack of evidence-based taste management strategies poses a significant challenge for clinicians in managing patients' taste alterations. These results emphasize the need to develop education and training material and identify effective treatment strategies to assist clinicians in providing better-quality care for patients suffering from taste alterations.
DOI: 10.29245/2578-2967/2024/1.1207 View / Download Pdf