Oncology: Palliative Care in SA Flashcards
What is palliative care?
Relieving pain without dealing with the cause of the condition
- Improved QoL
- Applicable early in the course of illness
When does palliative care start?
Before even diagnosis
What is quality of life?
An individuals satisfaction with:
* Its physical domain and phychological health
* Its physical and social environment
* Ability to interact with that environment
What comes under physical domain, emotional domain, social domain role/function?
Physical
* Grooming
* General acitivies
* Lethargy, sedation
* Clinical parameters
Emotional
* Hapiness
* Depression
* Attitude
Social/Role
* relationship with owners
How can quality of life be assessed?
Questionaire
How can quality of life be improved?
- Pain managment
- Owners expectations
- Treatment of cancer specific signs
- Nutrition
- Treatment of side effects
- Pain managment
- Alternative medicine
How can pain be recognised?
Physical reponse
* Palpation, self trauma, vocalisation
Measurable paremeters
* Appetite change, increases HR
* Appearance of coat
Activity gait and posture
* Reduced activity
Attitude and expression
* Attitude change
* Facial expression
* Sleep disturbance
What are the different options for pain treatment?
- NSAIDs
- Opioids
- Paracetamol
- Local
- A2 agonists
- NMDA agonists- ket
- When are NSAIDs contraindicated?
- When are prostoglandin receptor antagonists useful?
- What is contraindicated in cats?
- Corticosteroids
- Safe and effectvie in dogs with OA
- Paracetamol
- What is the action of tramadol?
- What is its main action?
- Opioidergic/monoaminergic
- Weak U-agonists
Doubt its efficacy in dogs
- What is gabapentin useful for?
- What is amantadine?
- Neuropathic pain
- NMDA agonist
Other then drugs what can be used for pain managment of osteosarcoma?
Radiation therapy
Cell death of both neoplastic osteoblasts and resorbing osteoclasts
How can bisphosponates be used for pain managment of osteosarcomas?
Induction of osteoclasts apoptosis
How can pain be managed by symptom relief?
Amputation
* Surgical exision of ulcerated/painful mass
Stenting- urethra, trachea
Cystotomy tubes
Why is nutrition important for cancer patient?
- Anorexia is a common occurence- cancer/treatment
- Weight loss is a common negative prognostic factor
What causes anorexia and cachexia?
Anorexia
* oral/abdominal pain
* Use of chemotherapy
* Cytokine release
Cachexia
* Cytokine release
* Extensive lipolysis, proteolysis
* Insulin resistance
What diet is reccomended?
Well balanced
* Commercial diet
* Home-made- need for veterinary nutritionalist
Comorbs
* CKD
* Diabetes mellitus
Monitor BW, BCS, Muscle condition
What feeding techniques can be used to help with anorexia?
Change diet- slowly
Change consistency
Small frequent meals
Warm up
What medications and assissted feeding techniques can be used for anorexia?
Medications
* Manage vomiting/nausea
* Mitrazapine: TCA
* Cyproheptadine
* Ghrelin analogue
Assisted feeding techniques
* Oesophagostomy tubes
* PEG tubes
What are the pros and cons of steroids?
Pros
* Can stimulate appetite
* useful for round cell tumour
* Reduce inflammation
Cons
* Weak analgesia
* Preclude NSAIDs
* Muscle wastage side effect
* No effects on carcinoma/sarcoma
* Can prevent diagnosis
* Can create resistance
What alternative medicine may be used?
Acupuncture
* Neuromodulation
* Main benefit in pain control/anti-emetic
Herbs/mushrooms
* Theoretical evidence
* Possibly harmful
Cannaboids
* Possible positive effects
When is euthanasia appropriate?
- Primary purpose to relieve suffering
- Joint decision
- Mention- some owners feel bad
