Terminal care

Question 1

What is the main aim of palliative care?

Answer 1

Treat symptoms of disease (pain, nausea, BO, SOB) without cure
Meeting the patient’s social, psychological and spiritual needs

Question 2

What gynaecological cancer normally requires palliative management?

Answer 2

Ovarian (but only 30% women are cured of their cancer)

Question 3

What care levels are involved?

Answer 3

GP
Specialist practitioners e.g. Macmillan nurses
Specialist hospitals/gynaecology units

Question 4

How is pain managed in palliative care?

Answer 4

WHO pain ladder (non opioids e.g NSAIDs; Mild opioids e.g. low dose to high dose codeine; strong opioids e.g. morphine)
Co-analgesics e.g. anti-depressants, steroids, cytotoxics may also be used; anti-emetics if indicated
PCA
Alternative therapies e.g. acupuncture (for greater patient control)

Question 5

How is nausea and vomiting managed in palliative care?

Answer 5

Due to opiates, metabolic causes (e.g. uraemia), vagal stimulation (e.g. bowel distension) or psychological factors
Antiemetics (anticholinergics, anti-histamines, dopamine antagonists, 5HT-3 antagonists e.g. ondansetron)

Question 6

How is heavy PV bleeding managed in palliative care?

Answer 6

May occur with advanced cervical/endometrial cancers
High does progestogens
Radiotherapy (if has not previously been used)

Question 7

How are ascites and bowel obstruction managed in palliative care?

Answer 7

Typical of advanced ovarian cancer
Drain ascites
If obstruction partial, stool sofnters and metoclopramide (anti-emetic and pro-motility)
For complete obstruction, cyclizine and ondansetron for N&V, hyoscine for spasm
Surgical palliation only if acute single site obstruction (stents can be used)

Question 8

How is terminal distress managed in palliative care?

Answer 8

Good symptom control

Involvement of family for final moments