Oncology/Palliative Care

Question 1

Public health initiatives/interventions are one way of seeking to reduce the symptoms and/or the causes of health inequalities. Which part of the UK has the highest incidence of cancer?

1 - London
2 - north west
3 - north east
4 - west midlands

Answer 1

3 - north east

Linked to deprivation, with most deprived having the highest rate of cancers

Question 2

All of the following cancers have a higher incidence in black ethnicities, EXCEPT which one?

1 - prostate cancer
2 - stomach cancer
3 - multiple myeloma
4 - colon cancer

Answer 2

4 - colon cancer

Question 3

Which part of the UK has the highest cancer mortality?

1 - northern Ireland
2 - wales
3 - England
4 - Scotland

Answer 3

4 - Scotland

Linked to deprivation

Question 4

Which of the following factors is linked to the deprivation gap and higher incidences of cancers?

1 - alcohol
2 - obesity
3 - smoking
4 - inactivity

Answer 4

3 - smoking

Linked specifically to smoking related cancers, such as smoking, laryngeal and oral cancers

Question 5

Which is the only cancer that has a lower incidence in the more deprived groups?

1 - laryngeal
2 - stomach
3 - malignant melanoma
4 - liver

Answer 5

3 - malignant melanoma

Linked with more money to holiday and spend time in the sun

Question 6

Which of the following is a potential reason for why patients from low socio-economic groups have a higher cancer incidence and mortality?

1 - delayed diagnosis
2 - increased comorbidities
3 - treatment issues
4 - all of the above

Answer 6

4 - all of the above

• Delays in Diagnosis (advanced stage of disease at presentation, emergency admissions, poor uptake of screening)
• Treatment (delays, poorer access to optimal care and lower compliance)
• Worse general health in more deprived groups.

Question 7

Which of the following matches the definition of inequality?

1 - differences that are unfair and avoidable
2 - differences within a social group
3 - differences understanding of health care
4 - any of the above

Answer 7

2 - differences within a social group

Gender, disability, ethnicity can all result in inequality, BUT these differences are unavoidable!

Cannot help if your male or disabled

Question 8

What has been suggested as the key feature that if corrected would remove the socio-economic gradient?

1 - access to health care
2 - obesity
3 - finances
4 - all of the above

Answer 8

1 - access to health care

Question 9

Which of the following matches the definition of inequity?

1 - differences that are unfair and avoidable
2 - differences within a social group
3 - differences understanding of health care
4 - any of the above

Answer 9

1 - differences that are unfair and avoidable

For example access to healthcare. This is avoidable, and if adjusted removes socio-economic gaps

Question 10

Of all the cancers linked to alcohol, which has the highest incidence associated with alcohol?

1 - breast
2 - larynx
3 - oesophagus
4 - liver

Answer 10

1 - breast

Question 11

Which of the following is an example of a public health initiative to reduce alcohol intake?

1 - increased activity
2 - increased drinking age
3 - increased unit price of alcohol
4 - increased labelling of risks on alcohol

Answer 11

3 - increased unit price of alcohol

For example 50p per unit in Scotland

Question 12

Do people living in higher or lower socioeconomic areas drink more alcohol?

Answer 12

• higher socioeconomic areas

BUT lower socioeconomic areas suffer with more alcohol related harm

Question 13

55 y/o male with in hospital with pancreatic cancer is started on MST, which is oramorph at 15mg BD PO. However, he is regularly getting pain throughout the day. What would be the total PO that the patient can be given PRN PO?

1 - 30mg
2 - 60mg
3 - 15mg
4 - 5mg

Answer 13

4 - 5mg

15 x 2 - 30mg/24h
30 / 6 - 5mg PRN for breakthrough pain

Typically given in a range, so would use 5-10mg PRN or oramorph would be fine

Question 14

If a patient is on 15mg BD PO or oramorph, there total would be 30mg/24h and their break through PRN would be 5mg (30/6). However, how many of the PRN are patients permitted to take in a 24h window?

1 - 2
2 - 4
3 - 6
4 - 10

Answer 14

3 - 6

Can write every 4/6 hours on the prescribing chart

Question 15

65 y/o male with prostate cancer and bony metastases in the spine and renal impairment with an eGFR of 37. Currently on 2 x Cocodamol 30/500 QDS and Diclofenac 50mg TDS (both stage 2 of the pain ladder), but his pain has been increasing.

After a discussion and careful thought, you decide to increase his regular analgesia. He would prefer to be on a tablet. If we switch the patient to morphine tablets (oxycodone), what would the dose be in morphine PO?

1 - 0.24mg/24h
2 - 24mg/24h
3 - 240mg/24h
4 - 2400mg/24h

Answer 15

2 - 24mg/24h

PO morphine is 10 fold stronger than Cocodamol

2 x Cocodamol 30/500 QDS = (30x2) x 4 = 240mg/24h (codeine)

Diclofenac 50mg TDS = 50 x 3 = 150mg

OXYCODONE IS THE SAFEST ORAL MORPHINE MEDICATION ON THE KIDNEYS

Question 16

If we want to change from morphine (24mg/24h) to Oxynorm, what would the dose of Oxynorm be?

1 - 24mg/24h
2 - 48mg/24h
3 - 96mg/24h
4 - 12mg/24h

Answer 16

4 - 12mg/24h

Oxynorm is twice as strong as morphine

This could be prescribed at 5mg TDS of Oxynorm (quick release of oxycodone)

Question 17

78y/o female with terminal throat cancer has been managing her pain with tramadol 100mg QDS (400mg/24h) but comes to see you as she has been struggling to swallow tablets. She decides to try a fentanyl patch, what does will you give to her if the patch lasts 72h?

Answer 17

• Patient on 100mg x 4 = 400mg
• Oral morphine 10x stronger than tramadol = 400/10 = 40mg/24h

60mg oral morphine = 25mcg of fentanyl

You agree to trial a fentanyl patch which needs to be changed every 72 hours.
You decide to start her on the lowest dose fentanyl patch which is 12mcg/hr every 72 hours.
You also prescribe her oramorph for her breakthrough pain (5-10mg PO every 4 hours).

Question 18

An 80 y/o woman who has reached the final stages of her metastatic colon cancer wishes to die at home.
She is currently bed bound and struggling to swallow her pain medication (MST 30mg BD and oramorph 10mg PRN). Her family tell you she has not really needed any oramorph recently. What will the dose of MST and oramorph be per 24h?

1 - MST 60mg and oramorph 10mg
2 - MST 120mg and oramorph 5mg
3 - MST 30mg and oramorph 25mg
4 - MST 30mg and oramorph 5mg

Answer 18

4 - MST 30mg and oramorph 5mg

• MST 30mg BD = 60mg PO/24h
• 60/2 = 30mg/24h SC, which is twice as potent at oral morphine

Breakthrough pain:
30/6 = 5mg of oramorph SC/24h

You decide to reassess after 24 hours as there is inter-individual variability with effect and side effects.