Palliative Radiation Flashcards
What are the three steps to working in a palliative care environment?
Understand dying–>Understand person–>understand our mission
Kubler Ross 5 stages of grief?
Denial, Anger, Bargaining, depression, acceptance
May not move on from each stage
Principles of Palliative care?
affirms life and treats dying as a normal process;
neither hastens nor postpones death;
provides relief from pain and other distressing symptoms;
integrates the physical, psychological, social, emotional and
spiritual aspects of care, with coordinated assessment and
management of each person’s needs;
offers a support system to help people live as actively as
possible until death; and
offers a support system to help the family cope during the
person’s illness and in their own bereavement.
3 components that make up holistic care?
Physical
Emotional
Spiritual
Side effects of pain medication? e.g morphine
- Constipation
- Nausea and Vomiting
- Drowsiness, impaired concentration
Temporal effects of treatment? (NOW and tonight)
Now
- Mild Pain
- Weakness
- Headaches
Tonight
- ->Severe pain
- -> Insomnia
Common Psychological symptoms?
- Worry
- Feeling sad
- Feeling nervous
- Sleep difficulty
- Irritability
- Difficulty concentrating
Managing palliative patients?
Empathy • Allow space • Understand journey- changes will occur • Family members are also experiencing loss- may be part of the process of care
COMMUNICATE!
Your challenges regarding palliative care?
Oncology is emotionally difficult • High incidence of burnout • Difficult patients • Unsolvable problem • Inherent discomfort with dying • Personal experiences
Challenges treating CNS patients?
• Physical- Pain , confusion , immobility , neurological , other cancer effects, drugs eg
steroids, morphine
• Emotional- Drugs effects, depression, cycle of loss, Anger, fear
• Spiritual- Faith , lack of faith, miracles ,
Practical-Mask , timing of treatment, family issues, conflicting interests, Swelling from
steroids
What factors need to be considered in order to provide best palliation?
- Will RT help this person?
- prognosis?
- patient factors?
- are there alternatives?
- Timing
- Dose fractionation
Benefits and Risks of using radiation to treat bone pain?
Benefits- • 60-80 % improvement • 40-50% complete • Decrease opioids • Bone stability • Increased functioning
Risks- • 1 to 10 treatments • Side effects – • Inconvenience • Cos
RT benefits for treating brain tumours?
- Prevents progression
- Survival benefit
- Painless and improves pain
- Decreases steroids
- Hair loss, skin reaction
Impact of Spinal Cord compression?
High index of suspicion • Pain increasing +++ • Weakness, bladder and bowel dysfunction • Weakness progressing to paralysis • SE: Fatigue/nausea
Benefits of using RT in emergency?
Rapid onset of symptoms leading to irreversible paralysis • Early intervention allows for preservation of neurological function in up to 80% people • Reduces pain
Bleeding impact? and the benefits of using RT in this situation?
- Emotionally distressing
- Physically debilitating
- Life threatening
RT -Arrests bleeding in >50% • SE manageable-depending on the site • 1-10 treatments
Cancer Wound impact? And how can RT benefit wound patients?
-Social embarrassment
• Painful
• Burden of dressing
RT
• Tips balance back to repair
• 10 treatments
• Prevents deterioration
Impact of Obstruction on patients?
-Distressing symptoms
-RT reduces tumour bulk
-Opens lumen-palliation
-Minimal side effects-depending
on the site
Swelling Impact? How can RT benefit patients with swelling?
- Blocked Lymphatic drainage
- Swollen limbs
RT • Reduces swelling • Relieves pain • Minimal side effects • 10 treatments
Common side effect and treatment?
Nausea- Zofran Diarrhoea- Gastro-stop Burning-Skin lotion Mucositis-Opioids Hair loss-none Fatigue-none Oesophagitis- Mylanta
Prognostication in cancer patients?
ECOG, karnosky, palliative care scores.
ECOG palliative cancer scoring
0-No limitation 1- Symptoms 2-Functionality impaired for <50% day 3-Functionality impaired for>50% day 4-100% bedbound 5-Dead
Patient with psoas muscle invasion. unable to extend legs/lie flat due to severe pain. How are you going to manage this patient?
Keep patient legs flexed
• Lie on his side
• Re- CT Simulation
• Palliative RT 30/10
