For patients with incurable malignancies who are reaching the end of life, palliating symptoms and maximising quality of life become the main goals of treatment. Palliative care aims to support those with life-threatening illnesses, including cancers, by addressing all biopsychosocial aspects of their care. This should include support for the patient and their family from the entire multidisciplinary team.
Other chapters have discussed two of the most common problems for palliative patients: nausea and pain. However, there are many other issues that may affect such patients, and controlling them can make a great difference to quality of life.
Physical symptoms
Constipation: there are numerous possible causes for constipation in cancer patients. The most common include drug side effects (particularly with opioid analgesia and anti-emetics), reduced fluid and nutritional intake, intestinal obstruction (due to tumour or strictures) and hypercalcaemia. Mobilisation and increased oral intake can help encourage bowel activity, but often softening or stimulating laxatives need to be administered. When prescribing opioid analgesia, concurrent use of a laxative should always be considered.
Diarrhoea: multiple factors may be involved. Pathogenic causes should be excluded, such as Norovirus or C. difficile infection. Drugs that can cause diarrhoea include chemotherapy, NSAIDs, antibiotics and laxatives. Radiotherapy can cause acute and delayed diarrhoea with onset many months after completion of treatment. It is important to identify overflow diarrhoea secondary to constipation, and a rectal examination may be necessary. Removal of the underlying cause is preferable, but if this is not appropriate, treatment with drugs such as loperamide (an opioid receptor agonist) may be beneficial.
Breathlessness: this can be due to many factors, which if reversible should be corrected. Respiratory causes include direct effect of lung tumours, pneumonia, pleural effusion, respiratory muscle weakness, phrenic nerve damage and rib metastases. Cardiovascular causes include congestive cardiac failure, pulmonary embolus, anaemia, arrhythmias and pericardial effusion. Anxiety is an important factor to consider, either as a primary cause or worsening an underlying condition. Oxygen can help if the patient is hypoxic, or even as a placebo to relieve anxiety, and opioids may help to reduce the respiratory rate and calm the patient. Benzodiazepines are useful in reducing anxiety.
Cough:
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
