Palliative care in small animal oncology Flashcards
What is palliative care?
« relieving pain without dealing with the cause of the condition »
“Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, and is applicable early in the course of the illness, in conjunction with other therapies that are intended to prolong life.”
What are primary concerns for vets + owners?
- 90% of owners will trade quantity for quality of life
What does quality of life include?
- Physical domain
- Emotional domain
- Social domain
- Role / function
** Subjective **
What are 4 features of health-related quality of life?
- Appetite
- Pain
- Mobility
- Behaviour
What are consequences of pain?
- Decreased QoL
- Alter physiologic functions
How can you assess pain?
- Physical responses
- Measurable parameters
- Activity, gait and posture
- Attitude and expression
Whats the best approach for pain?
- Multimodal approach
- NSAIDs
- Opioids
What are good/bad about NSAIDs / paracetamol?
- NSAIDs (meloxicam, carprofen, robenacoxib…)
- Very good painkiller; possible anti-tumour effect (carcinoma)
- ! Contra-indicated with corticosteroids, GI/kidney issues
- Prostaglandin receptor antagonists (Grapiprant)
- Safe and effective in dogs with OA
- ! Not with other NSAIDs or corticosteroids
- Paracetamol (+/- codeine)
- Good painkiller
- Not in cats!!!!
- Liver function??
- Can use with corticosteroids
Whats good / bad about tramadol?
- Opioidergic/monoaminergic drug
- Main action: weak µ-agonist
- Can cause dysphoria, sedation, nausea
- Doesn’t work in dogs
- works well in cats but Not palatable
What are other adjuvants that you could use?
- Gabapentin
- Mechanism of action unclear
- Neuropathic pain
- Can cause mild sedation and ataxia
- Delayed onset of action, wean off slowly
- Amantadine
- Minimal evidence of action, delayed onset of action
- Minimal side effects (lethargy, dizziness)
- NMDA antagonist
- Oral buprenorphine
- Tricyclic antidepressant (amitriptyline, clomipramine, fluoxetine)
- NGF monoclonal antibody
What is the mechanism of pain with osteosarcoma?
- Tumour associated inflammation (due to neoplastic osteoblasts)
- Bone destruction (due to osteoclasts)
What can be done to manage pain with osteosarcoma?
- Multimodal analgesia
- Radiation therapy - kill neoplastic osteoblast/clasts
- Bisphosphonates - osteoclast apoptosis
- Amputation
What is pain management depending on symptom?
- Amputation
- Surgical excision of ulcerated / painful mass
- Stenting - urethra / trachea
- Cystotomy tubes - urethral obstruction - not long term
What is the difference between anorexia + cachexia? Causes?
- Cachexia = inflammatory process - destroy muscle + fat (Extensive lipolysis/proteolysis, insulin resistance)
- Anorexia = doesn’t eat + doesn’t have fat (oral/abdominal pain w neoplasia / use of chemotherapy)
What should nutritional management be for neoplastic animals?
- Well-balanced diet - consider comorbidities (CKD / Diabetes mellitus) + Supplements - omega 3
- Monitor body weight
