Oncology: Palliative Care in SA

Question 1

What is palliative care?

Answer 1

Relieving pain without dealing with the cause of the condition

• Improved QoL
• Applicable early in the course of illness

Question 2

When does palliative care start?

Answer 2

Before even diagnosis

Question 3

What is quality of life?

Answer 3

An individuals satisfaction with:
* Its physical domain and phychological health
* Its physical and social environment
* Ability to interact with that environment

Question 4

What comes under physical domain, emotional domain, social domain role/function?

Answer 4

Physical
* Grooming
* General acitivies
* Lethargy, sedation
* Clinical parameters

Emotional
* Hapiness
* Depression
* Attitude

Social/Role
* relationship with owners

Question 5

How can quality of life be assessed?

Answer 5

Questionaire

Question 6

How can quality of life be improved?

Answer 6

• Pain managment
• Owners expectations
• Treatment of cancer specific signs
• Nutrition
• Treatment of side effects
• Pain managment
• Alternative medicine

Question 7

How can pain be recognised?

Answer 7

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

Question 8

What are the different options for pain treatment?

Answer 8

• NSAIDs
• Opioids
• Paracetamol
• Local
• A2 agonists
• NMDA agonists- ket

Question 9

1. When are NSAIDs contraindicated?
2. When are prostoglandin receptor antagonists useful?
3. What is contraindicated in cats?

Answer 9

1. Corticosteroids
2. Safe and effectvie in dogs with OA
3. Paracetamol

Question 10

1. What is the action of tramadol?
2. What is its main action?

Answer 10

1. Opioidergic/monoaminergic
2. Weak U-agonists

Doubt its efficacy in dogs

Question 11

1. What is gabapentin useful for?
2. What is amantadine?

Answer 11

1. Neuropathic pain
2. NMDA agonist

Question 12

Other then drugs what can be used for pain managment of osteosarcoma?

Answer 12

Radiation therapy

Cell death of both neoplastic osteoblasts and resorbing osteoclasts

Question 13

How can bisphosponates be used for pain managment of osteosarcomas?

Answer 13

Induction of osteoclasts apoptosis

Question 14

How can pain be managed by symptom relief?

Answer 14

Amputation
* Surgical exision of ulcerated/painful mass

Stenting- urethra, trachea

Cystotomy tubes

Question 15

Why is nutrition important for cancer patient?

Answer 15

• Anorexia is a common occurence- cancer/treatment
• Weight loss is a common negative prognostic factor

Question 16

What causes anorexia and cachexia?

Answer 16

Anorexia
* oral/abdominal pain
* Use of chemotherapy
* Cytokine release

Cachexia
* Cytokine release
* Extensive lipolysis, proteolysis
* Insulin resistance

Question 17

What diet is reccomended?

Answer 17

Well balanced
* Commercial diet
* Home-made- need for veterinary nutritionalist

Comorbs
* CKD
* Diabetes mellitus

Monitor BW, BCS, Muscle condition

Question 18

What feeding techniques can be used to help with anorexia?

Answer 18

Change diet- slowly
Change consistency
Small frequent meals
Warm up

Question 19

What medications and assissted feeding techniques can be used for anorexia?

Answer 19

Medications
* Manage vomiting/nausea
* Mitrazapine: TCA
* Cyproheptadine
* Ghrelin analogue

Assisted feeding techniques
* Oesophagostomy tubes
* PEG tubes

Question 20

What are the pros and cons of steroids?

Answer 20

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

Question 21

What alternative medicine may be used?

Answer 21

Acupuncture
* Neuromodulation
* Main benefit in pain control/anti-emetic

Herbs/mushrooms
* Theoretical evidence
* Possibly harmful

Cannaboids
* Possible positive effects

Question 22

When is euthanasia appropriate?

Answer 22

• Primary purpose to relieve suffering
• Joint decision
• Mention- some owners feel bad