Skip to main content

2016 | OriginalPaper | Buchkapitel

13. Verzicht auf invasive Maßnahmen beim geriatrisch-onkologischen Patienten

verfasst von : S. Wienand, H. -R. Raab

Erschienen in: Onkologische Chirurgie bei alten Patienten

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Der Kern ärztlichen Handelns ist Hilfe für den Kranken. Das ursprüngliche „Primum nil nocere“ wurde schon in antiker Zeit elaboriert zum „Salus aegroti suprema lex“. Das trifft den Kern therapeutischer Bemühungen besser. Während nämlich im Subtext der ersten Maxime mitschwingt, dass man im Zweifel Handlungen zu unterlassen habe, beinhaltet die zweite Formulierung die Erkenntnis, dass man auch durch Unterlassen schaden kann. Am Wohl des Kranken orientiert, gilt es also, das eine bewusst zu tun und anderes als ebenso bewusste Entscheidung auch zu unterlassen. Therapie in der ursprünglichen Wortbedeutung ist eben auch nicht stets ein aktives Tun. Das altgriechische Wort „therapeia“ bedeutete nicht nur Heilung sondern auch Pflege oder einfach Dienst. Der „theràpon“ war Diener oder Weggefährte. Aller ärztlicher Dienst am Kranken ist demnach letztlich Therapie.
Literatur
Zurück zum Zitat Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97:72–78CrossRefPubMed Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97:72–78CrossRefPubMed
Zurück zum Zitat American Geriatric Society (2002) The management of persistent pain in older persons. J Am Geriatr Soc 50:S205–S224CrossRef American Geriatric Society (2002) The management of persistent pain in older persons. J Am Geriatr Soc 50:S205–S224CrossRef
Zurück zum Zitat Audisi RA, Ramesh H, Longo WE, Zbar AP, Pope D (2005) Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist 10:262–268CrossRef Audisi RA, Ramesh H, Longo WE, Zbar AP, Pope D (2005) Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist 10:262–268CrossRef
Zurück zum Zitat Audisio RA. et al (2008) Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help A SIIOG surgical task force prospective study. Crit Rev Oncol Hematol 65:156–63. Epub 2007 Dec 21CrossRefPubMed Audisio RA. et al (2008) Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help A SIIOG surgical task force prospective study. Crit Rev Oncol Hematol 65:156–63. Epub 2007 Dec 21CrossRefPubMed
Zurück zum Zitat Auret K, Schug SA (2005) Underutilisation of opioids in elderly patients with chronic pain: aproaches to correcting this problem. Drug Aging 22:641–654CrossRef Auret K, Schug SA (2005) Underutilisation of opioids in elderly patients with chronic pain: aproaches to correcting this problem. Drug Aging 22:641–654CrossRef
Zurück zum Zitat Baron, TH; Harewood, GC (2003) Enteral self-expendable Stents. Gastrointest Endosc 58:421–433CrossRefPubMed Baron, TH; Harewood, GC (2003) Enteral self-expendable Stents. Gastrointest Endosc 58:421–433CrossRefPubMed
Zurück zum Zitat Bundesärztekammer (2010) Empfehlung der Bundesärztekammer und der Zentralen Ethikkommission bei der Bundesärztekammer zum Umgang mit Vorsorgevollmacht und Patientenverfügung in der ärztlichen Praxis. Dt Ärztebl 170: (18)A877–882, Bundesärztekammer (2010) Empfehlung der Bundesärztekammer und der Zentralen Ethikkommission bei der Bundesärztekammer zum Umgang mit Vorsorgevollmacht und Patientenverfügung in der ärztlichen Praxis. Dt Ärztebl 170: (18)A877–882,
Zurück zum Zitat Carraro PG, Segala M, Cesana BM, Tiberio G (2001) Obstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery. Dis Colon Rectum 44:243–250CrossRefPubMed Carraro PG, Segala M, Cesana BM, Tiberio G (2001) Obstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery. Dis Colon Rectum 44:243–250CrossRefPubMed
Zurück zum Zitat Clark AJ, Ahmedzai SH, Allan LG, et al (2004) Efficacy and safety of transdermal fentanyl and sustained-released oral morphine in patients with cancer and chronic non-cancer pain. Curr Med Res Opin 20:1419–1428CrossRefPubMed Clark AJ, Ahmedzai SH, Allan LG, et al (2004) Efficacy and safety of transdermal fentanyl and sustained-released oral morphine in patients with cancer and chronic non-cancer pain. Curr Med Res Opin 20:1419–1428CrossRefPubMed
Zurück zum Zitat Closs S (2005) Assessment of pian in older people – the key to effective management. Anaesth Crit Care 16:40–45CrossRef Closs S (2005) Assessment of pian in older people – the key to effective management. Anaesth Crit Care 16:40–45CrossRef
Zurück zum Zitat Davies E, Higginson J (Hrsg) (2004) Better palliative care for older people. Booklet. World Health Organization, Regional Office for Europe Davies E, Higginson J (Hrsg) (2004) Better palliative care for older people. Booklet. World Health Organization, Regional Office for Europe
Zurück zum Zitat European Pain in Cancer Survey, European Association of Palliative Care (2007) Half of European cancer patients have moderate to severe pain: one in five patients does not receive treatment. J Pain Palliat Care Pharmacother 21:51–53 European Pain in Cancer Survey, European Association of Palliative Care (2007) Half of European cancer patients have moderate to severe pain: one in five patients does not receive treatment. J Pain Palliat Care Pharmacother 21:51–53
Zurück zum Zitat Flacker JM, Lipsitz LA (1999) Neural mechanisms of delirium: current hypotheses and evolving concepts. J Gerontol A Biol Sci Med Sci 54:B239–B246CrossRef Flacker JM, Lipsitz LA (1999) Neural mechanisms of delirium: current hypotheses and evolving concepts. J Gerontol A Biol Sci Med Sci 54:B239–B246CrossRef
Zurück zum Zitat Guo MG, Feng Y, Zheng Q, Di JZ, Wang Y et al (2011) Comparison of self-expanding metal stents and urgent surgery for left-sided malignant colonic obstruction in elderly patients. Dig Dis Sci 56:2706–2710CrossRefPubMed Guo MG, Feng Y, Zheng Q, Di JZ, Wang Y et al (2011) Comparison of self-expanding metal stents and urgent surgery for left-sided malignant colonic obstruction in elderly patients. Dig Dis Sci 56:2706–2710CrossRefPubMed
Zurück zum Zitat van Hooft J, Mutignani M, Pepici A, Messmann H, Neuhaus H (2007) First data on the palliative treatment of patients with malignant gastric outlet obstruction using the WallFlex enteral stent: a retrospective multicenter study. Endoscopy 39:434–439CrossRefPubMed van Hooft J, Mutignani M, Pepici A, Messmann H, Neuhaus H (2007) First data on the palliative treatment of patients with malignant gastric outlet obstruction using the WallFlex enteral stent: a retrospective multicenter study. Endoscopy 39:434–439CrossRefPubMed
Zurück zum Zitat Jeurnink SM; Steyerberg EW, Van ’T Hoft G, Van Eijck CHJ, Kuipers EJ, Siersema PD (2007a) Gastrojejunostomy versus Stent Impantation in Patients with malignant gastric Outlet Obstruction: A comparison in 95 Patients. J Surg Oncol 96:389–396CrossRefPubMed Jeurnink SM; Steyerberg EW, Van ’T Hoft G, Van Eijck CHJ, Kuipers EJ, Siersema PD (2007a) Gastrojejunostomy versus Stent Impantation in Patients with malignant gastric Outlet Obstruction: A comparison in 95 Patients. J Surg Oncol 96:389–396CrossRefPubMed
Zurück zum Zitat Jeurnink SM, Van Eijck CHJ, Steyerberg EW, Kuipers EJ, Siersma PD (2007b) Stent versus Gastrojejunostomy for the palliation of gastric outlet obstruction. A systematic review. BMC Gastroenterology 7:18; doi:10.1186/1471-230X-7-18CrossRefPubMedPubMedCentral Jeurnink SM, Van Eijck CHJ, Steyerberg EW, Kuipers EJ, Siersma PD (2007b) Stent versus Gastrojejunostomy for the palliation of gastric outlet obstruction. A systematic review. BMC Gastroenterology 7:18; doi:10.1186/1471-230X-7-18CrossRefPubMedPubMedCentral
Zurück zum Zitat Jeurnink SM, Styerberg EW, Van Hoft JE et al (2010) Surgical Gastrojejunostomie or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENTstudy): A multicenter randomized trial. Gastrointest Endosc 71:490–499CrossRefPubMed Jeurnink SM, Styerberg EW, Van Hoft JE et al (2010) Surgical Gastrojejunostomie or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENTstudy): A multicenter randomized trial. Gastrointest Endosc 71:490–499CrossRefPubMed
Zurück zum Zitat Keränen I, Kylänpää L, Udd M, Louhimo J, Lepistö A, Halttunen J, Kokkola A (2013) Gastic Outlet Obstruction in Gastric Cancer: A Comparision of three palliative Methodes, J Surg Oncol 108:537–541CrossRefPubMed Keränen I, Kylänpää L, Udd M, Louhimo J, Lepistö A, Halttunen J, Kokkola A (2013) Gastic Outlet Obstruction in Gastric Cancer: A Comparision of three palliative Methodes, J Surg Oncol 108:537–541CrossRefPubMed
Zurück zum Zitat Khashab M, Alawad AS, Shin EJ, Kim K, Bourdel N et al (2013) Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc 27:2068–2075CrossRefPubMed Khashab M, Alawad AS, Shin EJ, Kim K, Bourdel N et al (2013) Enteral stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Surg Endosc 27:2068–2075CrossRefPubMed
Zurück zum Zitat Manderson L (2005) Boundary breaches: the body, sex and sexuality after stoma surgery. Soc Sci Med 61:405–415CrossRefPubMed Manderson L (2005) Boundary breaches: the body, sex and sexuality after stoma surgery. Soc Sci Med 61:405–415CrossRefPubMed
Zurück zum Zitat Mansoor H, Zeb F (2015) Enteral stents are safe and effective to relieve malignant gastric outlet obstruction in the elderly. J Gastrointest Canc 46:42–47CrossRef Mansoor H, Zeb F (2015) Enteral stents are safe and effective to relieve malignant gastric outlet obstruction in the elderly. J Gastrointest Canc 46:42–47CrossRef
Zurück zum Zitat Marquis P, Marrel A, Jambon B (2003) Quality of Life in Patients with Stomas: The Montreux Study. Osteomy Wound Manage 49; 48–55 Marquis P, Marrel A, Jambon B (2003) Quality of Life in Patients with Stomas: The Montreux Study. Osteomy Wound Manage 49; 48–55
Zurück zum Zitat Mendelsohn RB, Gerdes H, Markowitz AJ, DiMaio CJ, Schattner MA (2011) Carcinomatosis is not a contraindication to enteral stenting in selected patients with malignant gastric outlet obstruction. Gastrointest Endosc 73(6):1135–1140CrossRefPubMed Mendelsohn RB, Gerdes H, Markowitz AJ, DiMaio CJ, Schattner MA (2011) Carcinomatosis is not a contraindication to enteral stenting in selected patients with malignant gastric outlet obstruction. Gastrointest Endosc 73(6):1135–1140CrossRefPubMed
Zurück zum Zitat Pergolizzi J, Böger RH, Budd K, Dahan A, Erdine S et al (2008) Opioids and the Management of Chronic Severe Pain in the Elderly: consensus Statement of an International Expert Panel with Focus on the Six Clinically Most Often Used World Health Organization step III Opioids (Buprenorphine, Fentanyl, Hydromorphone, Methadone, Morphine, Oxycodone. World Institute of Pain, Pain Prac Vol.8(4): 287–313CrossRef Pergolizzi J, Böger RH, Budd K, Dahan A, Erdine S et al (2008) Opioids and the Management of Chronic Severe Pain in the Elderly: consensus Statement of an International Expert Panel with Focus on the Six Clinically Most Often Used World Health Organization step III Opioids (Buprenorphine, Fentanyl, Hydromorphone, Methadone, Morphine, Oxycodone. World Institute of Pain, Pain Prac Vol.8(4): 287–313CrossRef
Zurück zum Zitat Phillips RK, Hittinger R, Fry JS, Fielding LP (1985) Malignant large bowel obstruction. Br J Surg 72:296–302CrossRefPubMed Phillips RK, Hittinger R, Fry JS, Fielding LP (1985) Malignant large bowel obstruction. Br J Surg 72:296–302CrossRefPubMed
Zurück zum Zitat Stower MJ, Hardcastle JD (1985) The results of 1115 patients with colorectal cancer treated over an 8-year period in a single hospital. Eur J Surg Oncol 11:119–123PubMed Stower MJ, Hardcastle JD (1985) The results of 1115 patients with colorectal cancer treated over an 8-year period in a single hospital. Eur J Surg Oncol 11:119–123PubMed
Zurück zum Zitat Scarpa M, Barollo M, Polese L, Keighly MR (2004) Quality of Life in Patients with ileostomy, A decriptive survey Study on the Effect of Age on Quality of Life following Stoma Surgery. Minerva Chir 59 :23–29PubMed Scarpa M, Barollo M, Polese L, Keighly MR (2004) Quality of Life in Patients with ileostomy, A decriptive survey Study on the Effect of Age on Quality of Life following Stoma Surgery. Minerva Chir 59 :23–29PubMed
Zurück zum Zitat Satariano WA, Ragland DR (1994) The effect of comorbidity on 3-year survival of women with primary breast cancer. An Int Med 120:104–110CrossRef Satariano WA, Ragland DR (1994) The effect of comorbidity on 3-year survival of women with primary breast cancer. An Int Med 120:104–110CrossRef
Zurück zum Zitat Sharp L, Patel D, Clarke S (2011) The relationship between body image disturbance and distress in colorectal cancer patients with and without stomas. J Psychosom Res 70:395–402CrossRef Sharp L, Patel D, Clarke S (2011) The relationship between body image disturbance and distress in colorectal cancer patients with and without stomas. J Psychosom Res 70:395–402CrossRef
Zurück zum Zitat Sideris L, Zenasni F, Vernerey D, Dauchy S, Lasser P et al (2005) Quality of life of patients operated on for low rectal cancer: impact of the type of surgery and patients’ characteristics. Dis Colon Rectum 48:2180–2191CrossRefPubMed Sideris L, Zenasni F, Vernerey D, Dauchy S, Lasser P et al (2005) Quality of life of patients operated on for low rectal cancer: impact of the type of surgery and patients’ characteristics. Dis Colon Rectum 48:2180–2191CrossRefPubMed
Zurück zum Zitat Stower MJ, Hardcastle JD (1985) The results of 1115 patients with colorectal cancer treated over an 8-year period in a single hospital. Eur J Surg Oncol 11:119–123PubMed Stower MJ, Hardcastle JD (1985) The results of 1115 patients with colorectal cancer treated over an 8-year period in a single hospital. Eur J Surg Oncol 11:119–123PubMed
Zurück zum Zitat Ward SE, Goldberg N, Miller-McCauley V et al (1993) Patient–related barriers to management of cancer pain. Pain 52:319–324CrossRefPubMed Ward SE, Goldberg N, Miller-McCauley V et al (1993) Patient–related barriers to management of cancer pain. Pain 52:319–324CrossRefPubMed
Zurück zum Zitat Wehkamp K-H (2001) Das Alterskriterium beim Therapieverzicht – Empirie, Theorie undEthik, Die Kunst des Alterns. Medizinethische Diskurse über den Alterungsprozess in exogener Einflussnahme Peter Lang – Europäischer Verlag der Wissenschaften S. 221–228 Wehkamp K-H (2001) Das Alterskriterium beim Therapieverzicht – Empirie, Theorie undEthik, Die Kunst des Alterns. Medizinethische Diskurse über den Alterungsprozess in exogener Einflussnahme Peter Lang – Europäischer Verlag der Wissenschaften S. 221–228
Zurück zum Zitat Wong SK, Pang Y, Widder S, Khadaroo RG (2013) A Descriptive Survey Study on the Effect of Age on Quality of Life Following Stoma Surgery; Osteomy Wound Manage 59:16–23 Wong SK, Pang Y, Widder S, Khadaroo RG (2013) A Descriptive Survey Study on the Effect of Age on Quality of Life Following Stoma Surgery; Osteomy Wound Manage 59:16–23
Metadaten
Titel
Verzicht auf invasive Maßnahmen beim geriatrisch-onkologischen Patienten
verfasst von
S. Wienand
H. -R. Raab
Copyright-Jahr
2016
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-48712-9_13

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.