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Palliative reconstructive surgery: contextualizing palliation in resource-poor settings.

Nthumba PM - Plast Surg Int (2014)

Bottom Line: Surgical training does not arm the surgeon with the skills needed to deal with the care of palliative patients.Resource constraints demand that the surgeon be multidiscipline trained so as to be able to adequately address the needs of a growing population of patients that could benefit from surgical palliation.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Plastic, Reconstructive and Hand Surgery Unit, AIC Kijabe Hospital, Kijabe 00220, Kenya.

ABSTRACT
Introduction. Palliative care in Kenya and the larger Sub-Saharan Africa is considered a preserve of hospices, where these exist. Surgical training does not arm the surgeon with the skills needed to deal with the care of palliative patients. Resource constraints demand that the surgeon be multidiscipline trained so as to be able to adequately address the needs of a growing population of patients that could benefit from surgical palliation. Patients and Methods. The author describes his experience in the management of a series of 31 palliative care patients, aged 8 to 82 years. There were a total of nine known or presumed mortalities in the first year following surgery; 17 patients experienced an improved quality of life for at least 6 months after surgery. Fourteen of these were disease-free at 6 months. Conclusion. Palliative reconstructive surgery is indicated in a select number of patients. Although cure is not the primary intent of palliative surgery, the potential benefits of an improved quality of life and the possibility of cure should encourage a more proactive role for the surgeon. The need for palliative care can be expected to increase significantly in Africa, with the estimated fourfold increase of cancer patients over the next 50 years.

No MeSH data available.


Related in: MedlinePlus

(a) Synchronous osteosarcomas of the maxilla and mandible in a patient placed under palliative medical management. Picture © 2012 Nthumba; licensee BioMed Central Ltd [7]. (b) Postoperative picture at 2 years.
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fig5: (a) Synchronous osteosarcomas of the maxilla and mandible in a patient placed under palliative medical management. Picture © 2012 Nthumba; licensee BioMed Central Ltd [7]. (b) Postoperative picture at 2 years.

Mentions: The surgeon in rural sub-Saharan Africa is therefore not infrequently confronted by patients with lesions that are at first glance unresectable. The size of the tumor and its presentation, often ulcerated, infected, and exuding a foul smelling discharge, can be overwhelming (Figures 1, 2, 3(a), 4, 5(a), and 6(a)). The reflex healthcare provider response in this environment is predictable: “nothing can be done”; besides the risk of death, the cost of care may be prohibitive, while the projected postoperative quality of life may at best be poor.


Palliative reconstructive surgery: contextualizing palliation in resource-poor settings.

Nthumba PM - Plast Surg Int (2014)

(a) Synchronous osteosarcomas of the maxilla and mandible in a patient placed under palliative medical management. Picture © 2012 Nthumba; licensee BioMed Central Ltd [7]. (b) Postoperative picture at 2 years.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4230194&req=5

fig5: (a) Synchronous osteosarcomas of the maxilla and mandible in a patient placed under palliative medical management. Picture © 2012 Nthumba; licensee BioMed Central Ltd [7]. (b) Postoperative picture at 2 years.
Mentions: The surgeon in rural sub-Saharan Africa is therefore not infrequently confronted by patients with lesions that are at first glance unresectable. The size of the tumor and its presentation, often ulcerated, infected, and exuding a foul smelling discharge, can be overwhelming (Figures 1, 2, 3(a), 4, 5(a), and 6(a)). The reflex healthcare provider response in this environment is predictable: “nothing can be done”; besides the risk of death, the cost of care may be prohibitive, while the projected postoperative quality of life may at best be poor.

Bottom Line: Surgical training does not arm the surgeon with the skills needed to deal with the care of palliative patients.Resource constraints demand that the surgeon be multidiscipline trained so as to be able to adequately address the needs of a growing population of patients that could benefit from surgical palliation.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Plastic, Reconstructive and Hand Surgery Unit, AIC Kijabe Hospital, Kijabe 00220, Kenya.

ABSTRACT
Introduction. Palliative care in Kenya and the larger Sub-Saharan Africa is considered a preserve of hospices, where these exist. Surgical training does not arm the surgeon with the skills needed to deal with the care of palliative patients. Resource constraints demand that the surgeon be multidiscipline trained so as to be able to adequately address the needs of a growing population of patients that could benefit from surgical palliation. Patients and Methods. The author describes his experience in the management of a series of 31 palliative care patients, aged 8 to 82 years. There were a total of nine known or presumed mortalities in the first year following surgery; 17 patients experienced an improved quality of life for at least 6 months after surgery. Fourteen of these were disease-free at 6 months. Conclusion. Palliative reconstructive surgery is indicated in a select number of patients. Although cure is not the primary intent of palliative surgery, the potential benefits of an improved quality of life and the possibility of cure should encourage a more proactive role for the surgeon. The need for palliative care can be expected to increase significantly in Africa, with the estimated fourfold increase of cancer patients over the next 50 years.

No MeSH data available.


Related in: MedlinePlus