Palliative care

Distinguish the treatment goals of palliative care versus those of first-line treatment. 

The treatment of recurrent disease depends on the time to recurrence. If the time to recurrence is less than 6 months, second-line therapy should be considered if the patient has an acceptable performance status (see Patient Care and Monitoring ). The most widely accepted second-line therapies in SCLC are topotecan alone or CAV [cyclophosphamide, doxorubicin (Adriamycin), vincristine]. Relapses occurring more than 6 months after treatment warrant a repeat of the initial regimen. Poor performance status patients (3—4) typically are treated with palliative care therapies. 

Develop a care plan based on treatment goals. If the goal is palliative care, how does treatment-related toxicity influence therapy ... 

Methylnaltrexone was launched in 2008 for the treatment of OIC in patients with advanced illness receiving palliative care, when response to laxative therapy has not been sufficient. Due to its poor oral bioavailability, 4 is administered subcutaneously every other day. Approximately 50% of the drug is excreted in the urine and feces with 85% eliminated unchanged [30]. 

Nelson K, Walsh D, Deeter P, Sheehan F. (1994). A phase II study of delta-9-tetrahydrocannabinol for appetite stimulation in cancer-associated anorexia. J Palliative Care. 10(1) 14-18. 

Methadone is an opioid analgesic that is available for oral and parenteral administration. It is used in severe pain, in palliative care and as an adjunct in the management of opioid dependence. Compared with morphine, it is less sedating and has a longer duration of action. It may lead to addiction and can still cause toxicity when used in adults with non-opioid dependency. Because of the long duration of action, in overdosage, patients need to be monitored for long periods. 

Collins K, Harding R. Improving HIV management in sub-Saharan Africa how much palliative care is needed AIDS Care 2007 19(10) 1304-6. 

Miles CL, Fellowes D, Goodman ML, Wilkinson S. Laxatives for the management of constipation in palliative care patients. Cochrane Database Syst Rev 2006. 

When the number of patients within each centre is expected to be very small, it may not be practical to stratify the randomisation by centre. In that case it should be considered whether randomisation could be stratified by, for example, country or region. Such a choice might be driven by similarities in co-medication, palliative care or other factors that might make stratification advisable. ... 

Morrison LJ, Morrison RS Palliative care and pain management. Med Clin N Am 2006 90 983. [PMID 16962853]... 

States should enact legislation to provide for. .. safe and effective medication at an affordable price. States should also take measures necessary to ensure for all persons, on a sustained and equal basis, the availability and accessibility of quality goods, services and information for HIV/AIDS. .. treatment..., including antiretroviral and other safe and effective medicines, diagnostics and related technologies for preventive, curative and palliative care of HIV/AIDS and related opportunistic infections and conditions. (UNCHR/UNAIDS 2003)... 

O Siordin, L. The role of transdermal fentanyl in palliative care, Clin. Drug Invest. 1998, 16, 71-72. 

In addition to its use as a contraceptive, medroxyprogesterone acetate has also been used to treat benign prostatic hyperplasia, in which intermediate doses (for example 150 mg) are used (5), and to stimulate the appetite in patients receiving palliative care for cancer, although little published work can be found to support the latter indication. 

Anonymous. Medroxyprogesterone and palliative care new indication. No impact on quality of life. Prescrire Int 2001 10(51) 3 1. 

Wilkinson, S. (1995). Aromatherapy and massage in palliative care Does it improve patients quality of life. Int.J. Palliat.. Nurs. 1, 15—20. 

Gilligan, N.P. (2005) The palliation of nausea in hospice and palliative care patients with essential oils of Pimpinella anisum (aniseed), Foeniculum vulgare var. dulce (sweet fennel), Anthemis nobilis (Roman chamomile) and Mentha x piperita (peppermint). International journal of Aromatherapy 15(4), 1 63-167. 

Watson M, Lucas C, Hoy A (2006) Chapter One Pain. In Adult Palliative Care Guidance, 2nd edn. South West London, Surrey, West Sussex and Hampshire and Sussex Cancer Networks and Northern Ireland Palliative Medicine Group. 

Kronenberg, R. H. Ketamine as an Analgesic Parenteral, Oral, Rectal, Subcutaneous, Transdermal and Intranasal Administration. Journal of Pain and Palliative Care Pharmacotherapy 16 (3) (2002) 27-35. 

Kamboj SK, Tookman A, Jones L, Curran HV. The effects of immediate-release morphine on cognitive functioning in patients receiving chronic opioid therapy in palliative care. Pain 2005 117(3) 388-95. 

Antineoplastic and immunosuppressant drugs and drugs used in palliative care... 

Drugs used in palliative care The drugs are included in the relevant sections of the model list, according to their therapeutic use, e.g. analgesics... 

Drugs in palliative care symptom control pain... 

Tricyclic antidepressants may reduce morphine requirement in palliative care without noticeably altering mood. 

Malignant disease requires the full range of analgesics and adjuvant drugs and procedures (see Palliative care, below). 

Headache of raised intracranial pressure (cerebral oedema) responds to dexamethasone (10 mg i.v. 4 mg 6-hourly, 2-10 d) which reduces the pressure and to nonopioid anedgesics (see also Palliative care). 

As the scope of life contracts, so the quality of what remains becomes more precious. Symptoms should not be allowed to destroy it. Drugs are preeminent in symptom control. An illustrative instance of success in palliative care is provided here by ... 

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