Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment.
It is important to keep in mind that most of the reports in the literature come from well-resourced countries, where more optimal treatment is generally started much sooner, and in people with much less advanced disease than typically occurs in sub-Saharan Africa, for instance.
For instance, patients must pay for chemo in Zimbabwe — and it is expensive. Anthony Harries of the MoH in Malawi. In this context, it becomes all the more important to engage the person with KS and their family in the treatment decision-making process — taking into consideration the stage of disease, whether the course of KS is indolent or rapidly progressive, whether it is causing functional disabilities or leading to their stigmatisation, and individual circumstances whether they must travel long distances for treatment, or the financial implications for care and treatment.
Symptom control is a key aspect of palliative care, and HIV clinicians should institute effective pain assessment and management, according to WHO guidelines for pain control, as early as possible. Even when someone with KS is on ART and chemotherapy that might achieve a complete response, healthcare workers should keep in mind how to make the subject more comfortable until their KS improves.
Real World Case Study 2, Dr Julia Downing We had a patient a few years ago who had severe KS in his legs — unfortunately he did not come for care until it was very severe in the right leg — he was in a lot of pain and his leg was very swollen with open lesions on it. We tried to give him some chemotherapy — which was not available near his home so he had to come into Kampala — he had three doses of vincristine which was all we had available and the swelling reduced a bit — however her was not well enough to travel to Kampala and so we treated him at home.
The main issues for him were: Stigma from the KS which could not be hidden Pain — it was very painful and we had to put him on 10mg oral morphine 4 hourly which was increased eventually to 25mg 4 hourly Immobility — due to the pain and swelling he was not mobile — he needed help to do everything and spent most of the time lying down on a mat on the floor.
Due to the advanced state of his disease he was cachexic and so had related problems of the skin, sores etc. Practical advice on reducing suffering in people with KS A pain assessment should be performed on every patient with aggressive KS.
Dexamethasone or betamethasone 2mg daily is useful as a co-analgesic where there is significant oedema and inflammation and amitriptylline mg nocte as a co-analgesic for the management of neuropathic pain.
Patients who experience lymphoedema may receive some benefit from gentle lymphoedema massage. Assessment of fungating tumours: Skin tumours that cannot be excised may give rise to very unpleasant odours, which may be distressing to the patient. It is important to apply general principles of wound care to managing KS lesions.
This may be challenging in resourc- poor settings where there is no access to water for regular cleansing of the wound. Cleanse regularly with salt water; use ripe paw paw for sloughing crush and apply twice daily for 5 days Hospice Africa Uganda,or apply charcoal, live yoghurt, or honey to the wound.
Commenting on this practice, Dr.
Treat topically with metronidazole, which reduces the offensive odour, dries up the discharge, assists with haemostasis and treats infection caused by anaerobic organisms. If topical metronidazole is not available, crushed metronidazole tablets can be used for topical application on the fungating area.
If the wound presents with a sinus metronidazole tablets or pessaries can be inserted into the sinus or orifice leading to smelly growth.
The number of tablets depends on the size of the wound. Leave wound uncovered if possible Hospice Africa Uganda, Another resource on managing fungating wounds can be found online here: A patient with KS needs significant emotional support not only in dealing with the HIV diagnosis and physical distress but also with the disfigurement, change in body image and social isolation that can occur as a result of this distressing manifestation of HIV.
Any HIV care team looking for further assistance in providing symptom relief and supportive care is advised to look up the palliative care organizations listed in the resources section below — with one caveat.
KS of skin and soft tissue also respond to radiotherapy that may be offered as a palliative intervention where radiotherapy services are available. Palliative chemotherapy may also be effective. ART has been shown to lead to complete or partial remission of KS, particularly in many people with less extensive disease.
There has been some speculation that HIV protease inhibitors can also have a direct effect on KS Sgadarialthough a recent study by Martinez et al. A subsequent study found in 78 people with KS found that treatment with ART led to a more durable response than chemotherapy on its own Bower ART may improve outcomes in resource-limited settings as well.
Among study subjects followed over two-and-a-half years in the study, there were 16 KS cases diagnosed at baseline and 17 occurred over the course of the study.The first information I received concerning the occurrence of Kaposi’s sarcoma in several gay men in New York City came from Dr Joyce Wallace.
She had received a biopsy report of a diagnosis of Kaposi’s sarcoma in one of our rutadeltambor.com?p= · The AIDS Memorial is a curated Instagram account, featuring heartbreaking stories of those lost due to HIV and AIDS.
Thousands of posts reveal the faces of rutadeltambor.com · Robert Boyle "Bobbi" Campbell Jr. (January 28, – August 15, ) was a public health nurse and an early United States AIDS activist. In September , Campbell became the 16th person in San Francisco to be diagnosed with Kaposi's sarcoma, when that rutadeltambor.com · HIV as a biological weapon is a very poor idea.
For starters, it takes far too long to produce fatalities and the infected are still able to operate in society or the military just as capably as the non-infected for possibly rutadeltambor.com://rutadeltambor.com · Kaposi's sarcoma is a rare form of skin cancer that started appearing in small populations of gay men in the early s.
Since it was previously known to occur mostly in older people with Mediterranean or Middle Eastern heritage, the sudden clustering of cases in young gay men was baffling until someone linked it to the HIV rutadeltambor.com://rutadeltambor.com · Ewing sarcoma.
A type of tumor that forms in bone or soft tissue, Ewing sarcoma often occurs in teenagers and young adults. It can show up in a variety of places. Standard treatment for Ewing sarcoma includes chemotherapy, radiation, surgery, targeted therapy and high-dose chemotherapy with stem cell rutadeltambor.com://rutadeltambor.com