Palliative and Supportive Care Flashcards
Palliative and Supportive Care
Which is FALSE?
I. The National Consensus Project defines palliative care as “patient and family-centered
care that optimizes quality of life by anticipating, preventing, and treating suffering.
II. Palliative care involves
addressing physical, intellectual, emotional, social, and spiritual needs and to
facilitate patient autonomy, access to information, and choice.
III. Palliative care may be delivered in a variety of settings including inpatient and outpatient care
IV. Palliative care may be delivered throughout the patient’s disease course, from initial diagnosis to the
end of life.
VI. The National Consensus Project has defined seven domains of
palliative care.
VI.
See Table 100.1
Palliative and Supportive Care
Which is/are FALSE?
I. Integration of palliative care into oncology care resulted in better quality of life and fewer depressive symptoms.
Additionally, patients receiving less aggressive medical interventions, randomized to early palliative care had similar median survival.
II. A similar median survival was also seen in the ENABLE III trial, which randomized patients to early or delayed palliative care.
III. Caregivers may also experience lower levels of depression and stress burden with early enrollment.
I. longer median survival
II. survival benefit
Palliative and Supportive Care
A recent trial of electronic
integration of PROMs in patients with metastatic cancer demonstrated improved
measures of quality of life and a significant survival benefit with the addition of
PROMs, with results guiding supportive care intervention.
TRUE or FALSE?
True
Palliative and Supportive Care
Yoga is proven to reduce cancer related fatigue in some patients.
TRUE or FALSE?
A meta-analysis of 113 studies examined the effect of exercise,
psychological interventions, and pharmacologic interventions for CRF.
This
analysis showed significant reduction in fatigue scores in cancer patients with
both exercise and psychological interventions but not with pharmacologic
interventions. Specifically, there is randomized evidence in support of the use of
yoga in reduction of CRF in patients being treated for breast and colorectal
cancer.
Palliative and Supportive Care
Radiation-associated fatigue typically less severe than chemotherapy-generated fatigue but is more commonly persistent even after completion of radiation and on follow-up.
TRUE or FALSE?
False.
short-lived and less severe.
Palliative and Supportive Care
The size of the radiotherapy field also relates to the likelihood of developing radiation-associated fatigue.
TRUE or FALSE?
True.
Palliative and Supportive Care
Cancer cachexia is defined if:
patients who have more than __% loss of stable body weight over the past 6 months,
or a body mass index (BMI) less than ___ and ongoing weight loss of more than __%,
or sarcopenia and ongoing weight loss of more than 2%.”
5% in 6 months
BMI <20; 2% ongoing
patients who have more than 5% loss of stable body weight over the past 6 months, or a body mass index (BMI) less than 20 kg/m2 and ongoing weight loss of more than 2%, or sarcopenia and ongoing weight loss of more than 2%.”
Palliative and Supportive Care
For patients with expected >30 days of impairment in nutritional intake due to treatment, what is the preferred nutritional support means, assuming other parameters are normal?
PEG
Palliative and Supportive Care
In patients without a functioning GI tract because of obstruction, poor GI motility, intractable vomiting, severe diarrhea, short bowel syndrome, or severe pancreatitis, what is the preferred alternative for delivering nutritional requirements?
TPN
Palliative and Supportive Care
Which is false in the pathophysiology of xerostomia?
I. Irradiated salivary glands demonstrate acinar atrophy and chronic inflammation.
II. Inflammatory changes and fibrosis are observed in periductal, ductal, and intralobular areas.
III. A 50% to 60% decrease in salivary flow occurs during the first week. As radiotherapy continues and the total radiation dose increases, salivary function decreases accordingly in a dose-dependent fashion.
IV. After initial deterioration, a recovery phase may be seen, with patients reporting reduced xerostomia even though salivary flow remains depressed.
V. salivary function usually continues to decline for 6 to 8 months after therapy, and many patients show no recovery even at 12 months.
II. Ductal systems remain intact
Palliative and Supportive Care
Limiting the mean dose of the parotid glands to ___ decreases the risk of long-term xerostomia.
≤26 Gy
Palliative and Supportive Care
Most common pharmacologic agent used in the “prevention” of xerostomia.
Amifostine
Palliative and Supportive Care
Most common pharmacologic agent used in the “treatment” of xerostomia.
Pilocarpine, a muscarine agonist
Palliative and Supportive Care
In patients with residual salivary function, what is the treatment of choice for xerostomia?
stimulation (gum, menthol, sugarless candies, lozenges)
Palliative and Supportive Care
In patients without residual salivary function, what is the treatment of choice for xerostomia?
artificial saliva
