Overview of Advanced cancer care- organization, and aspects of care- pain relief

1. ADVANCED MALIGNANCY
Patient care
Pain relieved

2. ADVANCE
MALIGNANCIES
-
GYNAECOLOGY
 Cervical cancer
 Breast cancer
 Ovarian cancer
 Uterine cancer
 Fallopian tube cancer

3. Global
perspective

4. The
dissemination
of training and
knowledge

5. Cancer risk

6. HOSPICE &
PALLIATIVE
CARE
FRAMEWORK
 Hospice – An institution that specializes in the care of
terminally ill patients with special concern for death with
dignity
 Central to this type of care is an interdisciplinary team
approach that typically encompasses pain, and symptoms
management spiritual and psychological care for the
patient and support for family caregivers

7. COMMON
PHYSICALAND
PSYCHOLOGICAL
AMONG
TERMINAL ILL
 Pain
 Fatigue
 Insomnia
 Anorexia
 Dyspnoea
 Depression
 Anxiety
 Nausea
 Vomiting
 Delirium (last day of life)

8. PAIN RELIEF
 Pain medications (non-opioid analgesics like NSAIDs , mild
opioid like codeine, strong opioids like morphine) - non-opioids
should be combined with opioids
Cases with a continuous pain
 Epidural Morphine
 Peripheral nerves block

9. INTERVENTION
FORURINARY
SYMPTOMS
 Catheterization
 Hemodialysis
 Use diapers
 Frequent changes of bed cloth and bedding

10. INTERVENTION
FOR
CONSTIPATION
 Fibers x with opioid
 Give stimulant, osmotic laxative, stool softener, fluids and
enemas.
 If persists - Rectal examination
 Palliative surgery to relieve intestinal obstruction

11. INTERVENTION
FORANOREXIA
 Force feeding
 Total parenteral nutrition (TPN)

12. INTERVENTION
FOR FATIGUE  air-mattress if necessary

13. INTERVENTION
FOR DYPSNEA
 Gives oxygen

14. INTERVENTION
FOR
PSYCHOLOGICAL
PROBLEM
 Depression – give psycho stimulants (e.g.
dextroamphetamine, mirtazepine)
 Delirium – supportive measures to provide a familiar
environment , with restricting visitors, eliminating new
experiences, orienting the patient with clock and
calendar,
 give haloperidol,

15. INTERVENTION
FOR FINANCIAL
BURDEN
 Assistance from social worker
 Option for long term care insurance

16. INTERVENTION
FOR
RELATIONSHIP
 Requires effort to facilitate the type of encounters and
time span with family and friends
 Physician and healthcare providers may facilitate and
resolved strained interactions between patient and
family
 Help create and preserve memories –photographs, video
and scrap books

17. INTERVENTION
FOR
EXISTENTIAL
NEEDS
 Promote the patient to indulge in religion and spirituality
aspects – may gain inner peace

18. CARE DURING
THE LAST
HOURS
 Oral swabbing
 Lubricants for the lips
 Scopolamine to reduce saliva secretions

19. PATIENTCARE
 Localized radiation therapy
 to relieve pressure or pain from mass lesion or
metastasized
 Palliative chemotherapy – depends on initial regimens
and evidence of drug resistance (gemcitabine, topotecan,
liposomal doxorubicin, vinorelbine,

20. conclusions
 Advanced malignancy is a common occurrence today, as
screening is still not widely accepted or feasible
 Management is basically symptom relief and supportive
care
 Care may be a long term one, and a good social, religious
and family is necessary for better outcomes.