Unit 5 - The Cancer Patient

Question 1

briefly outline palliative care

Answer 1

Uses a wide team of specialists (dietitian, physiotherapist, pharmacists, social workers to:

• Provides relief from pain
• Affirms life and regards dying as normal
• Neither to hasten or postpone death
• Integrate psychological and spiritual aspects
• Offer support to help the patient live as actively as possible, enhancing quality of life
• Offers a support system to help the family

Question 2

What is the definition of palliative care?

Answer 2

To improve the quality of life of patients and their families by means of easing physical pain as well as other psychological and spiritual issues.

Question 3

Describe some of the different ways pain can be treated in palliative care.

Answer 3

Convential drugs
Non-opioids (paracetamol) or opioids (codeine), anxiety (benzodiazepine)
Radiotherapy
Around 40% of radiotherapy is given for palliative care e.g., for bone metastasis for spinal cord compression. Treatment is given in short fractionated courses to minimise hospital visits
Glioblastoma multi-form – unusually high dose (60 Gy) is given to patients – so takes a lot of time (2x30days after surgery) and significant toxicity like dermatitis and somnolence syndrome, nausea – hence the length of survival period in these patients has to be worth it!!
Surgery
Toilet mastectomy in breast cancer – bleeding and secondary infection
Pining of pathological fractures (osteolytic lesion) – given that they have fairly long survival
Surgery for brain metastases – only for those who are in good healthy (can actually improve survival)
Chemotherapy
Side-effects must be minimal and manageable and the expected length of life is long enough to derive benefit – example would be bisphosphonates for breast cancer to help treat bone mets
Hormone therapy
Breast like tamoxifen or prostate orchidectomy

Question 4

List some of wide-array of side-effects associated with cancer chemotherapy?

Answer 4

• Myelosuppression (can be given growth factors and antibiotics)
• Nausea and vomiting – can be given anti-emetics
• Fatigue
• Mucositis – affect taste
• Diarrhoea
• Hair loss
• Weight loss/gain – mentality
• Depression – ESHAP treatment
• Some will cause chronic side-effects like Tratuzumab with the heart or potentially secondary cancers (alkylating agents or radiotherapy)
• And that doesn’t even cover cost!!!!

Question 5

Using prostate cancer as an example, discuss the impact of the four types of treatment available to the individual?

Answer 5

Surgery
Related to erectile dysfunction and incontinence – self-esteem issues which may affect relationships and fertility
Radiotherapy
Rectal inflammation, reduced fertility and erectile dysfunction
Chemotherapy
Cabazitaxel – GI problems, nausea, hair-loss, anaemia
Hormone therapy
Loss of sex drive and erectile dysfunction (in women this may be an early menopause with tamoxifen)
Can lead to financial loss leading to increased anxiety – as well as issues with relationships, fertility and self-confidence

Question 6

What issues might cancer survivors face?

Answer 6

Anxiety about recurrence, financial issues due to lack of working, loss of autonomy, transition back to a civilian rather than a patient