Palliative Treatment Flashcards
1
Q
Palliative Radiotherapy Principles
A
- Quality of Life
o Quality rather than quantity - Pain Relief
o Pain is often the most feared symptom of terminal cancer (two-thirds of patients experience significant pain)
o Pain is very personal, and everyone has a differing pain tolerance - Symptom Relief
o Breathlessness, anorexia, and weakness are also common symptoms
2
Q
Examples of Palliative Intent
A
- SVC Obstruction
o A mass pushes against the superior vena cava and impedes heart function
o Often treated urgently with RT, to reduce mass and alleviate symptoms - Osteolytic Bone Mets
o Eats in healthy bone by ‘lysing’ (cause destruction) bone, causing skeletal dysfunctions
o We want to stop that lytic function of the cells - Brain Mets
o Can disrupt the health function of the rest of the brain, causing confusion and dizziness among other things
o Aim of treatment is to relieve this impediment, effectively restoring normal function to the rest of the organ
3
Q
Palliative Treatment Sites
A
- Can be anywhere, but most common:
o Bone, Brain and Lung - Spinal cord compressions from bone metastases can result in:
o Bleeding complications in the bowel, upper and lower GI tract
o Fungating lesions involving the epidermis
4
Q
Pre-Treatment
A
- Lower T + L spine patient will experience nausea and vomiting
o Important to ensure patient has anti-emetics prescribed and taken prior to treatment
Long list of anti-emetics and all have different actions
Some may not work for some patients
Important to ask about specific symptoms
5
Q
Patient positioning and immobilisation equipment
A
- Assess, stability, immobilise or reproduce
- Patient is often already in extreme pain
o Comfort of the patient is paramount
o Uncomfortable = patient movement - Always consider soft-top
- Site Specific considerations
o Shell – Brain or C-Spine
o Shoulder reproducibility
o Incline – for difficulty lying flat
o Arm position for multi-field lung - General diligence, care and attention to detail
6
Q
Common Anti-emetics
A
- Domperidone – relieve nausea and vomiting
- Metoclopramide – treat heartburn
- Ondansetron/granesitron – prevent nausea and vomiting
- Cyclizine
- Dexamethasone - Is a steroid but has been used to control vomiting
7
Q
Name 5 side effects of dexamethasone
A
vision changes swelling rapid weight gain mood changes nausea
8
Q
Field Arrangements
A
- Minimal for minimal time on couch
- Low doses and low margins
- Critical structures – site specific
o Spinal cord for higher dose lung volumes
o Bowel for lower spines, - Larger margins allow for the reduced stability
o A patient in pain often moves without control
Would require a lower dosage
9
Q
Acute side effects of radiotherapy
A
o Oedema, epithelial irritation, presenting symptoms diarrhoea, nausea, vomiting, increased pain
o Fatigue, mild/moderate skin reactions
10
Q
Long term side effects of radiotherapy
A
o Oedema, growth stunting, fibrosis, cardiac damage, damage to optic chiasm, endocrine dysfunction, myelopathy, Lhermitte’s syndrome, infertility, carcinogenesis
11
Q
Psychosocial Considerations for palliative patients
A
o Terminally Ill o Cultural differences o Great pain o Require reassurance and comfort o Dysfunction and immobility o Impacts on dignity social impediments
12
Q
how to treat side effects
A
o Monitor and medicate
o Antiemetics: dexamethasone for ICP, narcotics painkillers, rest, aqueous cream
o Field shaping and field placement and patient position
o Often greater risks accepted for shorter life expectancy
13
Q
Lhermitte’s Sign
A
- Is a sudden sensation resembling an electric shock that passes down the back of your neck and into your spine and may then radiate out into your arms and legs
- It is usually triggered by bending your head forward towards your chest
- Conditions which can cause LS
o Myelopathy
Subacute combined degeneration from B12 deficiency
o Cervical Spine Inflammation
Can be caused by lupus, an infection or Bechet’s disease
o Transverse Myelitis
A sudden episode of spine dysfunction
Cervical spinal cord tumours
o Spondylosis
Arthritis in the neck, Chemotherapy, Trauma
14
Q
bone mets
A
- At autopsy around 70% of patients who die of cancer are shown to have skeletal mets.
Which primary tumours most commonly metastasise to bone?
- Breast
- Prostate
- Lung
- Any primary site can metastasise to bone
- Radiotherapy with good relief in 80 per cent of cases
- If the bone has already fractured, surgical stabilisation should be performed followed by postoperative radiotherapy
- Must balance symptom relief with sparing of normal tissues to minimise side effects (e.g., small bowel with pelvic treatments)
- Postoperatively, RT the entire prothesis or intramedullary nail should be covered with a margin of normal bone
o This is the area most at risk of residual tumour
15
Q
Types of Bone Mets
A
- Osteolytic
o Deposits in the bone that lyse (cause destruction) to surrounding bone cells
Lyse = destruction of cells or dissolution cells - Osteoblastic
o Cause formation of new bone that is often deformed and weak
o More prone to fracture
