The Dying Cancer Patient

Question 1

What are the two most common metabolic problems in cancer

Answer 1

1. Hyponatraemia

2. Hypercalcaemia (HPT)

Question 2

What are 4 symptoms caused by cancer

Answer 2

Primary Tumour

Distant Metastases
(paraneoplastic syndromes)

Body’s response to 1 + 2

Treatment given for any of the above

Question 3

What causes systemic problems in cancer

Answer 3

You get a systemic inflammatory response which reduces appetite, causes fevers etc.

Because the cancer cells are acting autonomously, releasing cytokines and other molecules

Question 4

Outline the systemic inflammatory cancer response: Neuroendocrine

Answer 4

Fever, Somnolence, Anorexia

Increase Cortisol + Catecholamines

Question 5

Outline the systemic inflammatory cancer response: Haematopoietic

Answer 5

Anaemia
Leucocytosis
Thrombocytosis

Question 6

Outline the systemic inflammatory cancer response: Metabolic

Answer 6

Reduced Muscle; -ve Nitrogen balance
ncreased Lipolysis
Cachexia

Question 7

Outline the systemic inflammatory cancer response: Hepatic

Answer 7

Increase Blood Flow

Increase Acute Phase Proteins

Question 8

Biochemical changes in cancer

Answer 8

falling albumin, falling Creatinine, Anaemia

Question 9

Compare the progression of cancer with, for example, organ failure

Answer 9

Doesn’t decline for a while, then a rapid decline in function

Organ is exacerbations and drops in functon in which you don’t return to baseline- gradual decline

Question 10

How good are doctors are predicting prognosis of cancer patients

Answer 10

Bad- tend to overestimate survival time

Question 11

Define fatigue

Answer 11

Tiredness that rest doesn’t relieve

Question 12

Physical symptoms associated with cancer

Answer 12

Fatigue, pain, breathlessness, anorexia, cough, constipation, depression, nausea, insomnia, anxiety

Question 13

A good phrase for ‘how would you manage x’

Answer 13

I would start by taking a full history, then examining the patient and then consider further investigations…

Question 14

Outline the WHO pain ladder

Answer 14

1. Non-opioid (NSAIDS/paracetemol)
2. Opioid for mid-mod pain (codeine, tramadol)
3. Opioid for mod-severe pain (morphine, fentanyl)

Question 15

Fatigue occurs in what percentage of cancer patients

Answer 15

Common symptom >80% advanced cancer patients.

Question 16

How do you treat fatigue

Answer 16

Graded physical exercise

No drugs have any evidence for long term benefit (most short term seems sleep restoration)

Question 17

Difference between anorexia and cachexia

Answer 17

Anorexia= loss of appetite 
Cachexia= loss of weight 

Not reversible with nutrition
No place for TPN or NG tibe

Question 18

What are the stages of change

Answer 18

Pre-Contemplation
Contemplation
Determination Preparation
Action
Maintenance
Relapse / Recycle

Question 19

Orders of hope

Answer 19

First Order:
Denial of Symptoms –> Hope for Recovery

Second Order:
Denial of Non-Recovery –> Hope beyond Recovery
e.g. for Dignity
e.g. to be free from pain

Third Order:
Hope in the Face of Existential Extinction
e.g. Chooses and affirms a stance concerning the Meaning of Life that allows them to choose what to Hope for.

Question 20

What is the relationship between breathlessness and o2 sats

Answer 20

No relationship

Question 21

What can reduce the feeling of breathlessness

Answer 21

Oxygen will improve the sats

Having a fan blowing over your face and shins

Question 22

……

Answer 22

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Question 23

…….

Answer 23

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Question 24

……

Answer 24

……..

Question 25

……..

Answer 25

………

Question 26

What happens to brain in breathlessness

Answer 26

Limbic/paralimbic activation occurs in air hunger

Also activated by awareness of other homeostatic threats, including pain, thirst and hunger

Such threats demand behavioural action, motivated by emotion