Download Eat five or more servings of a variety of vegetables and

• WHO defines palliative care as an approach that :
Affirms life and regards death as a normal process.
Does not hasten or postpone death.
Provides relief from pain and other symptoms.
Offers a support system to help patients live as actively as
possible right up to their death.
Integrates psychological and spiritual care.
Provides a wider support to help the family cope during the
patient’s illness and their own bereavement after death.
Pain control is central to palliative care, and presents
challenges in itself. The analgesia ladder, as developed
by WHO, includes three steps:
Step 1 : Aspirin or paracetamol.
Step 2 : Codeine or dihydrocodeine, with or without
non-steroidal or anti-inflammatory drugs such as
ibuprofen or indomethacin.
Step 3 : Morphine, with or without co-analgesia, and with or
without steroid anti-inflammatory drugs.Other strong
opioid analgesics include pethidin and fentanyl.
Eat five or more servings of a variety of vegetables and
fruits each day.
* Include vegetables and fruits at every meal and for snacks.
* Eat a variety of vegetables and fruits.
* Limit French fries, snack chips, and other fried vegetable products.
* Choose 100% juice if you drink fruit or vegetable juices.
Choose whole grains in preference to processed (refined)
grains and sugars.
* Choose whole grain rice, bread, pasta, and cereals.
* Limit consumption of refined carbohydrates, including pastries,
sweetened cereals, soft drinks, and sugars.
Limit consumption of red meats, especially
those high in fat and processed.
* Choose fish, poultry, or beans as an alternative to beef, pork, and lamb.
* When you eat meat, select lean cuts and smaller portions.
* Prepare meat by baking, broiling, or poaching, rather than by frying or
charbroiling.
Choose foods that help maintain a healthful weight
• When you eat away from home, choose food low in fat, calories, and sugar
and avoid large portions.
• Eat smaller portions of high-calorie foods. Be aware that
Examples of Moderate and Vigorous Physical Activities
Moderate
Activities
Exercise and
Leisure
Vigorous
Activities
Walking,
dancing,
Leisurely
bicycling,
ice-skating
or rollerskating,
horseback
riding,
canoeing,
yoga
Jogging or
running, fast
bicycling,
circuit
weight
training,
aerobic
dance,
martial arts,
jump rope,
swimming
Volleyball,
golfing,
softball,
baseball
Soccer, field
hockey or
ice hockey,
lacrosse,
singles
Moderate
Activities
Vigorous
Activities
Sports
Badminton,
doubles
tennis,
downhill
skiing
tennis,
racquetball,
basketball,
cross country
skiing
Home
Activities
Mowing the
lawn,
general lawn
and garden
maintenance
Digging,
carrying and
hauling,
masonry,
carpentry
Walking and
lifting as
part of the
job
(custodial
work, farming,
auto or machine
repair)
Heavy
manual
labor
(forestry,
construction,
fire fighting)
Occupational
Activity
Helpful Ways to Be More Active
•
•
•
•
Use stairs rather than an elevator.
If you can, walk or bike to your destination.
Exercise at lunch with your workmates, family, or friends.
Take a 10-minute exercise break at work to stretch or take a quick
walk.
• Walk to visit co-workers instead of sending an email.
• Go dancing with your spouse or friends.
• Plan active vacations rather than only driving trips.
• Wear a pedometer every day and watch your daily steps increase.
• Join a sports team.
• Use a stationary bicycle while watching TV.
• Plan your exercise routine to gradually increase the days per week
and minutes per session.
Maintain a healthful weight throughout life.
Balance caloric intake with physical activity.
Lose weight if currently overweight or obese.
Being overweight or obese is associated with an increased risk of
developing several types of cancer:
•
•
•
•
•
•
•
Breast (among postmenopausal women)
Colon
Endometrium
Esophagus
Gallbladder
Pancreas
Kidney
If you drink alcoholic beverages, limit consumption.
People who drink alcohol should limit their intake to no more than 2 drinks
per day for men and 1 drink a day for women. The recommended limit is
lower for women because of their smaller body size and slower
metabolism of alcohol. A drink is defined as 12 ounces of beer, 5 ounces
of wine, or 1.5 ounces of 80 proof distilled spirits.
Alcohol is an established cause of cancers of the:
•
•
•
•
•
•
Mouth
Pharynx (throat)
Larynx (voice box)
Esophagus
Liver
Breast
Alcohol may also increase the risk of colon cancer.
Diet and Physical Activity Factors That Affect Risks
for the Most Common Cancers
Although the nutrition and activity guidelines are intended to reduce
overall cancer risk, certain dietary and physical activity habits affect the
risk for developing specific types of cancer. This section summarizes the
relation of diet and physical activity factors to the common cancers in the
United States.
Bladder Cancer
The major risk factors for bladder cancer are tobacco smoking and
exposure to certain industrial chemicals. However, drinking more fluids
and eating more vegetables may lower the risk of bladder cancer.
Brain Cancer
There are no know nutritional risk factors for brain cancer.
Breast Cancer
The risk of breast cancer is increased by several factors that cannot be
easily changed:
• Having your first period before age 12
• Not having children or having your first birth after age 30
• Late age at menopause
• Family history of breast cancer
Other factors that increase risk, however, can be changed by :
• Limiting the use of hormones (hormone replacement therapy)
• Reducing alcohol consumption
• Breastfeeding
• Avoiding obesity
• Being physically active
The best advice to reduce the risk of breast cancer is to:
• Engage in vigorous physical activity at least 4 hours a week
• Avoid or limit your intake of alcohol to no more than one drink per
day
• Reduce lifetime weight gain through the combination of limiting
your calories and exercising regularly
Colorectal Cancer
The best advice to reduce the risk of colon cancer is to:
•
•
•
•
•
Increase your physical activity
Eat more vegetables and fruit
Limit intake of red meats
Avoid obesity
Avoid excess alcohol
Endometrial Cancer
Studies of endometrial cancer (cancer of the lining of the uterus) show
that obesity and use of hormonal replacement therapy after menopause
increase risk. The link to weight is thought to result from the increase in
estrogen levels that occurs among postmenopausal women who are
overweight.
The best advice to reduce the risk of endometrial cancer is to maintain a
healthful weight through diet and regular physical activity.
Kidney Cancer
Kidney cancer risk is increased among those who are overweight. The
reason for this is unknown. The best nutritional advice to lower risk for
kidney cancer is to avoid becoming overweight.
Leukemias and Lymphomas
There are no Known nutritional risk factors for leukemias or lymphomas.
Lung Cancer
More than 85% of lung cancers result from tobacco smoking. Many
studies have shown that the risk of lung cancer is lower among both
smokers and nonsmokers who consume at least five servings of
vegetables and fruits a day. Although healthful eating may reduce the risk
of lung cancer, the risks from tobacco smoking, chewing tobacco, and
snuff remain substantial. Using high doses of beta-carotene and/or
vitamin A has increased (not decreased) lung cancer risk among smokers
(see beta-carotene under Common Questions About Diet and Cancer).
The best advice to reduce the risk of lung cancer is to avoid tobacco use
or exposure and to eat at least five servings of vegetables and fruits every
day.
Oral and Esophageal Cancers
The best advice to reduce the risk of oral and esophageal cancers is to:
•
•
•
•
Avoid all forms of tobacco
Restrict alcohol consumption
Avoid obesity
Eat at least five servings of vegetables and fruits each day
Pancreatic Cancer
The best advice to reduce the risk of pancreatic cancer is to:
•
•
•
•
Avoid tobacco use
Maintain a healthful weight
Remain physically active
Eat five or more servings of vegetables and fruits each day
Prostate Cancer
For now, The best advice to reduce the risk of prostate cancer is to:
• Limit intake of animal products, especially red meat and high-fat
dairy products
• Eat five or more servings of vegetables and fruits each day
Stomach Cancer
The rates of stomach cancer are decreasing as a result of the reduced
prevalence of chronic stomach infections by the bacterium Helicobacter
pylori. Year-round consumption of fresh foods made possible by
refrigeration and other improvements in food preservation methods also
have likely helped to reduce the rates.
At this time, the best advice to reduce the risk of stomach cancer is to eat
at least five servings of vegetables and fruits daily.
Complementary and
Alternative Therapies
Complementary refers to supportive methods that are used to
Complement, or add to, mainstream treatments. Examples might include
meditation to reduce stress, peppermint tea for nausea, and acupuncture
for chronic back pain. Complementary methods are not given to cure
disease, rather they may help control symptoms and improve well-being.
Some of the methods, such as massage therapy, yoga, and meditation,
that are categorized as complementary have actually been referred to as
supportive care in the past.
Alternative refers treatments that are promoted as cancer cures. They
are unproven because they have not been scientifically tested, or were
tested and found to be ineffective. If used instead of evidence-based
treatment, the patient may suffer, either from lack of helpful treatment or
because the alternative treatment is actually harmful.
Some Helpful Complementary Approaches
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•
•
•
•
•
•
•
•
aromatherapy
art therapy
biofeedback
massage therapy
meditation
music therapy
prayer, spiritual practices
t’ai chi
yoga
Questions to Ask About Alternative and complementary Therapies
• What claims are made for the treatment: to cure the cancer or to enable the
evidence-based treatment to work better? To relieve symptoms or side
effects?
• What are the credentials of those supporting the treatment? Are they
recognized experts in cancer treatment? Have they published their findings
in trustworthy journals?
• How is the method promoted? Is it promoted only in the mass media (books,
magazines, TV and radio talk shows) rather than in scientific journals?
• What are the costs of the therapy?
• Is the method widely available for use within the health-care community,
or is it controlled with access to its use limited?
• If used in place of standard therapies or clinical trials, will the
Ensuing delay affect any chances for cure or advance the cancer
stage?
Signs of Treatments to avoid
•
•
•
•
•
•
Is the treatment based on an unproven theory?
Does the treatment promise a cure for all cancers?
Are you told not to use conventional medical treatment?
Is the treatment or drug a “secret” that only certain providers can give?
Does the treatment require you to travel to another country?
Do the promoters attack the medical/scientific establishment?
Breast • Yearly mammograms are recommended starting at age 40.The age at which
screening should be stopped should be individualized by considering the
potential risks and benefits of screening in the context of overall health status
and longevity.
• Clinical breast exam should be part of a periodic health exam, about every
three years for women in their 20s and 30s,and every year for women 40
and older.
• Women should know how their breasts normally feel and report any breast
change promptly to their health care providers. Breast self-exam is an option
for women starting in their 20s.
• Women at increased risk (e.g.,family history, genetic tendency, past breast
cancer)should talk with their doctors about the benefits and limitations of
starting mammography screening earlier, having additional tests (I.e.,breast
ultrasound and MRI), or having more frequent exams.
Colon & Beginning at age 50, men and women should follow one of the examination
rectum schedules below:
• A fecal occult blood test (FOBT) or fecal immunochemical test (FIT) every
year
• A flexible sigmoidoscopy (FSIG) every five years
• Annual FOBT or FIT and flexible sigmoidoscopy every five years*
• A double-contrast barium enema every five years
• A colonoscopy every 10 years
*Combined testing is preferred over either annual FOBT or FIT, or FSIG
every five years,alone.People who are at moderate or high risk for colorectal
cancer should talk with a doctor about a different testing schedule.
Prostate The PSA test and the digital rectal examination should be offered annually,
beginning at age 50, to men who have a life expectancy of at least 10 years.
Men at high risk (African American men and men with a strong family history
of one or more first-degree relatives diagnosed with prostate cancer at an early
age)should begin testing at age 45. For both men at average risk and high risk,
information should be provided about what is known and what is uncertain
about the benefits and limitations of early detection and treatment of prostate
cancer so that they can make an informed decision about testing.
Uterus Cervix : Screening should begin approximately three years after a woman
begins having vaginal intercourse, but no later than 21 years of age. Screening
should be done every year with regular Pap tests or every two years using
liquid-based tests. At or after age 30, women who have had three normal test
results in a row may get screened every two to three years.Alternatively,cervica
cancer screening with HPV DNA testing and conventional or liquid-based
cytology could be performed every three years. However, doctors may usggest
a woman get screened more often if she has certain risk factors, such as HIV
infection or a weak immune system.Women 70 years and older who have had
three or more consecutive normal Pap tests in the last 10 years may choose to
stop cervical cancer screening. Screening after total hysterectomy (with remova
of the cervix) is not necessary unless the surgery was done as a treatment for
cervical cancer.
Endometrium: The American Cancer Society recommends that at the time of
menopause all women should be informed about the risks and symptoms of
endometrial cancer, and strongly encouraged to report any unexpected bleeding
or spotting to their physicians. Annual screening for endometrial cancer with
endometrial biopsy beginning at age 35 should be offered to women with or at
risk for hereditary nonpolyposis colon cancer (HNPCC).
Moderate Physical Activity Examples*
Washing and waxing a car
Less Vigorous,
for 45-60 minutes
More Time
Washing windows or floors
for 45-60 minutes
Playing touch football
for 30-45 minutes
Playing volleyball for 45 minutes
Playing touch football
for 30-45 minutes
Gardening for 30-45 minutes
Wheeling self in wheelchair
for 30-40 minutes
Walking 1 3/4 miles in 35 minutes
(20 minutes per mile)
Basketball (shooting baskets)
for 30 minutes
Bicycling for 5 miles in 30 minutes
Dancing fast (social)1for 30 minutes
Pushing a stroller 1 /2 miles
in 30 minutes
Raking leaves for 30 minutes
Walking 2 miles in 30 minutes
(15 minutes per mile)
Water aerobics for 30 minutes
Swimming laps for 20 minutes
Wheelchair basketball for 20 minutes
Basketball (playing a game)
for 15-20 minutes
Bicycling 4 miles in 15 minutes
Jumping rope
for 15 minutes
Running 1 1/2 miles in 15 minutes
(10 minutes per mile)
More Vigorous,
Shoveling snow for 15 minutes
Less Time
Stairwalking for 15 minutes
*The amount of physical activity is influenced by its duration, intensity, and frequency.The same amount
of activity can be obtained in longer sessions of moderately intense activities (such as brisk walking) as in
shorter sessions of more strenuous activities (such as running).
Adapted from:
Chronic Disease Notes & Reports, a publication of the Centers for Disease Control and
Prevention.111
To achieve the American Cancer Society physical activity guidelines, adults may choose a variety of
activities. Some examples from the table above include:
• Bicycle 5 miles in 30 minutes
• Walk 2 miles in 30 minutes and run 11/2 miles in 15 minutes
• Garden for 30 minutes
• Play volleyball for 45 minutes
American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention
Recommendations for individuals
1. Eat a variety of healthful fools, with an emphasis on plant sources.
• Eat five or more servings of a variety of vegetables and fruits each day.
• Choose whole grains in preference to processed (refined) grains and sugars.
• Limit consumption of red meats, especially high-fat and processed meats.
• Choose foods that help maintain a healthful weight.
2. Adopt a physically active lifestyle.
• Adults should engage in at least moderate activity for 30 minutes or more on five or more days of
the week; 45 minutes or more of moderate to vigorous activity on five or more days per week may
further enhance reductions in the risk of breast and colon cancer.
• Children and adolescents should engage in at least 60 minutes per day of moderate to vigorous
physical activity at least five days per week.
3. Maintain a healthful weight throughout life.
• Balance caloric intake with physical activity.
• Lose weight if currently overweight or obese.
4. If you drink alcoholic beverages, limit consumption.
Recommendation for Community Action
Public, private, and community organizations should work to create social and physical environments
that support the adoption and maintenance of healthy nutrition and physical activity behaviors.
• Increase access to healthful foods in schools, worksites, and communities.
• Provide safe, enjoyable, and accessible environments for physical activity in schools and for
transportation and recreation in communities.
WHODEFINITION OF PALLIATIVE CARE
Palliative care is an approach that improves the quality of life of patients
and their families facing the problem associated with life-threatening
illness, through the prevention and relief of suffering by means of early
identification and impeccable assessment and treatment of pain and other
problems, physical, psychosocial and spiritual. Palliative care:
• provides relief from pain and other distressing symptoms;
• affirms life and regards dying as a normal process;
• intends neither to hasten or postpone death;
• integrates the psychological and spiritual aspects of patient care;
• offers a support system to help patients live as actively as possible until
death;
• offers a support system to help the family cope during the patient’s illness
and in their own bereavement;
• uses a team approach to address the needs of patients and their families,
including bereavement counselling, if indicated;
• will enhance quality of life, and may also positively influence the course of
illness;
• is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation
therapy, and includes those investigations needed to better understand
and manage distressing clinical complications.
ประเด็นปัญหาทีพ่ บในผู้ป่วยระยะสุ ดท้ าย
ปัญหาเศรษฐกิจ
1.1 ช่วยเหลือด้านค่ารักษาพยาบาล ร้อยละ 30.0
1.2 ช่วยเหลือสนับสนุนให้ได้รับสิ ทธิพึงมีพึงได้ดา้ นการรักษาพยาบาล ร้อยละ 58.3
1.3 ช่วยเหลือด้านค่าครองชีพ/เงินทุนประกอบอาชีพเพื่อช่วยเหลือครอบครัว 24 ราย/ปี
1.4 ช่วยเหลือด้านค่าพาหนะไป-กลับ 25 ราย/ปี
1.5 ช่วยเหลือด้านการจัดรถหรื อใช้รถพยาบาล ไปส่ งผูป้ ่ วยกลับบ้าน โรงพยาบาลใกล้บา้ น
20 ราย/ปี
1.6 จัดกิจกรรมฝึ กอาชีพส่ งเสริ มอาชีพให้ครอบครัว 2 ครั้ง/เดือน
1.7 ช่วยเหลือโลงศพและผ้าขาวห่อศพ ในกรณี ผปู ้ ่ วยยากไร้ 12 ราย/ปี
1.8 ช่วยเหลือค่าใช้จ่ายเป็ นกิจกรรมฌาปนกิจศพ ในผูป้ ่ วยยากไร้ 7 ราย/ปี
1.9 ช่วยเหลือจัดการฌาปนกิจศพ ให้แก่ผปู ้ ่ วยไม่มีญาติ / ตามความต้องการของผูป้ ่ วย 4 ราย/ปี
1.10 ช่วยเหลืออุปกรณ์ทางการแพทย์
- รถเข็น / Walker 7 ราย/ปี
- ให้ยมื เตียงและเบาะลมหมุนเวียนไปใช้จนกว่าผูป้ ่ วยเสี ยชีวติ และนามาคืนเพื่อให้
ผู้ป่วยรายอื่นต่อไป 12 ราย/ปี
- ให้ยมื เครื่ องดูดเสมหะ / ถังออกซิเจน / เครื่ องช่วยหายใจ 14 ราย/ปี
การช่ วยเหลือทางจิตใจและสั งคม
(Psychosocial Support)
หลักการของการบริบาล (Principle of Care)
1. Concern หมายถึง ความผูกพัน ความห่วงใย
2. Clinical competence หมายถึง ความสามารถทางคลินิก
3. Comfort หมายถึง การปลอมโยน
4. Compassion หมายถึง ความกรุ ณา
5. Communication หมายถึง การสื่ อสาร
6. Children หมายถึง เด็ก ๆ หรื อลูกหลาน
7. Cohesion หมายถึง ความเชื่อมแน่น
8. Cheerfulness หมายถึง ความร่ าเริ ง ความจริ ง
9. Consistency หมายถึง ความคงเส้นคงวา
ขอเพิ่มสาม E สาหรับแพทย์ที่รับผิดชอบในการดูแลผูป้ ่ วยในระยะสุ ดท้าย คือ
1) Empathy หมายถึง ความร่ วมรู ้สึกหรื อการมีอารมณ์ร่วมกัน
2) Encouragement หมายถึง การสนับสนุนเป็ นลักษณะของการให้กาลังใจ
3) Equanimity หมายถึง อุเบกขา คือความมีใจเป็ นกลาง
ประเด็นจริยธรรมของการดูแลด้ านจิตวิญญาณ
1.
2.
3.
4.
5.
การบอกข้ อมูลและการบอกความจริง (veracity, truth telling)
การบรรเทาความเจ็บปวด
การตัดสิ นใจเลือกวิธีการรักษาในหออภิบาลผู้ป่วยหนัก
ลางสั งหรณ์ ใกล้ตาย (Symbolic expression of dying patient)
การตอบสนองทางด้ านจิตวิญญาณเมื่อวาระสุ ดท้ ายมาถึง
Breaking bad news
หลัก 6 ขั้นตอนของ Robert Buckman
1.
2.
3.
4.
5.
6.
การเตรี ยมความพร้อม
ประเมินว่าผูป้ ่ วยรู ้เรื่ องของโรคมากน้อยแค่ไหน
ประเมินว่าผูป้ ่ วยต้องการรู ้ข่าวสารมากน้อยเพียงใด
แลกเปลี่ยนข่าวสาร
ตอบสนองต่ออารมณ์ของผูป้ ่ วย
การวางแผนและติดตามการรักษา
Dying Patients
Elizabeth Kubler Ross ได้รวบรวมข้อมูลจากประสบการณ์กบั ผูป้ ่ วยมะเร็ งและ
สรุ ปเป็ นปฏิกิริยาการปรับตัวของผูป้ ่ วยเพื่อรับกับความตาย ดังนี้
1.
2.
3.
4.
5.
The stage of denial
The stage of anger
The stage of bargaining
The stage of depression
The stage of acceptance
Medical professionals involved in breast cancer diagnosis and
treatment may include:
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Gynecologist or OB/GYN, family practitioner, or other primary care physician
Radiologist
Oncologist (general, medical, radiation, surgical)
Oncology nurse specialist
Oncology social works
Surgeon
Radiation therapy oncologist
Radiation therapy technologist
Radiation therapy physicist
Pathologist
Reconstructive/plastic surgeon
Life Beyond Cancer
 Post-Treatment Resource Program
Our Post-Treatment Resource Program offers help to former cancer patients
and their families.
 Educational Support Groups
Educational support groups led by Post-Treatment Resource Program staff.
 Upcoming Programs
Continually updated information about upcoming educational support groups.
 Counseling, Wellness & Complementary Medicine
Information about our support groups, seminars, workshops, and one-on-one
counseling for cancer survivors.
 Sexual Health
Help with issues of sexual health related to cancer and its treatment.
Survivorship & Support
* Follow-up Care
* Management of Complications
* Other Aspects of Survivorship
Outpatient Counseling
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Individual, Family & Group Counseling
Alleviating Distress & Other Symptoms
Mindfulness-based Stress Reduction
Quitting Smoking & Improving Health Habits
Neuropsychological Testing
Art Therapy
AIDS Supportive Care Program
Research Studies
For Information about Counseling Center Services
Post-Treatment Resource Program
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individual and family consultations
seminars and workshops
professionally led support groups
practical advice on insurance and employment issues
Educational Support Groups
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Autologous Stem Cell Transplant: Transitions
Bladder Cancer: Challenges & Solutions
Esophagectomy: Finding a new balance
Grace & Grit: A Women’s Circle
Head, Neck, and Oral Cancers: Moving Forward
Living Well Programs
Lung Cancer: Breathing Easier
Men & Cancer: Maintaining Focus
Primary Brain Tumors: A Gathering for Patients and Families
Time and Again: Living On and Off Treatment
Young Adults: New Challenges/New Beginnings
Classes : Fitness, Movement & Spiritual/Energy
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Yoga
The Alexander Technique
Qi Gong
T’ai Chi
Light Workout
Lengthen and Strengthen with Pilates Mat
Chair Aerobics
Focused Fitness for Women
Strong Bones
Abs & More
Individual Therapies
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Touch Therapies
Mind-body Therapies
Creative Therapies
Acupuncture
Nutrition and Herbal Counseling
Consultation
Education
Introductory Packages
Touch Therapies
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Aromatherapy Massage
Massage
Rejuvenating Scalp, Face & neck Massage
Reflexology
Reiki
Shiatsu
Thai Massage
Urban Hiker Tune Up
Mind-body Therapies
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Meditation
Mindfulness Based Stress Reduction (MBSR)
Guided Imagery
Self-Hypnosis
Pre-Surgery Hypnosis Program
Creative Therapies
• Music Therapy uses music to encourage healing and promote a general sense
of well-being. Under the guidance of a professionally trained music therapist,
patients listen to or perform music, which enhances relaxation, creativity,
pleasure, and self-expression and helps reduce pain and feelings of isolation.
• Sound Therapy, an ancient method of healing, is based on the idea that everything in the universe, including the human body, is in a constant state of vibration.
Sound therapy restores balance and provides a sense of calmness and inner peace
that allows the body to begin its healing process.
Acupuncture
• Acupuncture is the process of applying disposable, ultra-thin needles to
specific points on the body to stimulate the nervous system to release certain
chemicals in the brain.The improved energy and balance stimulates the body’s
natural healing abilities, relieves physical ailments, and promotes physical and
emotional well-being.
• Restorative Facial Acupuncture is a method of gentle, pain-free
acupuncture and acupressure that revitalizes the mind and body-a wonderful
way to look better and feel great.
• Tui Na (Acupressure) is a traditional Chinese technique using hand pressure
to specific points of the body to deeply relax muscles and promote blood
circulation.Tui Na can help relieve pain, reduce stress and improve physical
well being.
Nutrition and Supplement Counseling
• Nutrition and Supplement Counseling This individual session
includes scientifically-based recommendations for healthful eating
to encourage optimal well-being. As well as expert advice on the
proper use of supplements both for disease prevention and during
treatment.
Consultation
• Meet one of our clinicians to learn more about the therapies offered at
the Integrative Medicine Service and how they can benefit you. We
also offer acupuncture specific consultations. (Consultations are free
of charge).
Education
• Frequent workshops and lectures are available to patients, their
families, and members of the community.
Please call
1-212-639-4700.
Rehabilitation
The occupational and physical therapists who staff Memorial Sloan Kettering’s
physical rehabilitation department have special expertise in the care of patients
with cancer. These therapists work closely with physiatrists-physicians who
specialize in rehabilitation medicine-and other medical staff at Memorial SloanKettering to provide physical and occupational therapy to both inpatients and
outpatients and to improve patients’ sense of wellbeing during and after cancer
treatment. Through therapeutic exercise, neuromuscular training,patient and
family education, and pulmonary rehabilitation, our therapists help patients’
decrease the burden of disease and its treatment and regain their optimal
functional capacity.
Physical Therapy
Our physical therapy division is dedicated to enabling patients with
cancer to achieve their highest level of functional independence. Physical
therapists help patients improve their quality of life by planning and
administering individualized therapeutic exercise programs to restore
function, diminish pain, increase endurance and strength, increase safety
awareness, and incorporate patients’ personal goals. Physical therapy
services are offered both on an in-patient and out-patient basis.
Occupational therapy
Members of our occupational therapy division are dedicated to helping
patients with cancer regain and improve the skills essential for
independent functioning. Through skilled assessment techniques and a
holistic approach to care, occupational therapists help patients regain
independence in their daily activities such as dressing. Grooming,
bathing, and eating. They also work with patients to improve the
psychological, social, and environmental factors that may contribute to
patients’ quality of life.
Chemotherapy can bring major changes to your life.
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affect your overall health,
threaten your sense of well-being,
disrupt your daily routines,
and put a strain on your relationships.
Many people do not understand cancer and may withdraw
from you because they’re afraid of your illness.
• Others may worry that they will upset you by saying the
wrong thing.
Support groups
• companies are deciding more often not to pay for the use of
some chemotherapy drugs, even if those drugs are effective
cancer therapies.
• Before you begin treatment, find out whether your insurance
company or Medicare will pay for your care.
Advance Directives
• Advance directives are the legal documents, such as the living
will, durable power of attorney and health care proxy, which
allow people to convey their decisions about end-of-life care
ahead of time.
• Advance directives provide a way for patients to communicate
their wishes to family, friends, and health care professionals and
to avoid confusion later on, should they become unable to do so.
Living will?
A living will is a set of instructions documenting a person’s wishes
about medical care intended to sustain life.
• the use of life-sustaining equipment (dialysis machines, ventilators,
and respirators);
• “do not resuscitate” orders; that is, instructions not to use CPR if
breathing or heartbeat stops;
• artificial hydration and nutrition (tube feeding);
• withholding of food and fluids;
• palliative / comfort care; and
• organ and tissue donation.
A health care proxy is an agent (a person) appointed to make a
patient’s medical decisions if the patient is unable to do so.
Generally, people assign someone they know well and trust to
represent their preferences when they can no longer do so. Patients
should be sure to ask this person for agreement to act as their agent.
An agent may have to exercise judgment in the event of a medical
decision for which the patient;s wishes are not known.
The durable power of attorney for health care is the legal
document that names a patient’s health care proxy. Once
written, it should be signed, dated, witnessed, notarized, copied,
distributed, and incorporated into the patient’s medical record.
Hospice
• Hospice is a concept of care that involves health professionals
and volunteers who provide medical, psychological, and
spiritual support to terminally ill patients and their loved ones.
• Hospice stresses quality of life-peace, comfort, and dignity.
• A principal aim of hospice is to control pain and other symptoms
so the patient can
• The typical hospice patient has a life expectancy of 6 months or
less.
Home Care for Cancer Patients
Key points
• A doctor, nurse, or social worker can provide information about
patients’ specific needs, the availability of home care services, and
a list of local home care agencies.
• Services provided by home care agencies may include access to
medical equipment; visits from registered nurses, physical therapists,
and social workers; help with running errands, meal preparation, and
personal hygiene; and delivery of medication.
• Medicare may offer reimbursement for some home care services.
• At a minimum, states must provide home care services to people who
receive Federal income assistance such as Social Security Income and
Aid to Families with Dependent Children.
• Veterans who are disabled as a result of military service can receive
home care services from the Department of Veterans Affairs (VA).