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Complex Issues in Radiotherapy > Palliative care > Flashcards

Palliative care Flashcards

(121 cards)

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1
Q

what is the goal of palliative care

A

control symptoms and enhance QoL

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2
Q

what is palliative and end of life care

A

care provided to any pt for whom cure is not achievable, including those who may survive with progressive disease for many mths or years

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3
Q

when is a referral for specialist care done

A

multiple co-morbidities
disease burden
life limiting disease
high levels of planned hospital use
high level of planning ahead
symptom management not responding >48hrs after trt
complexity in one or more aspects of care

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4
Q

what is a holistic needs assessment

A

a questionaire that the pt fills out at any part of the pathway

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5
Q

why is a HNA good

A

develop a personalised care + support plan
starts a convo on needs
identifies pt concerns
sign post to relevant services
share the right info at the right time

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6
Q

what is the palliative care approach

A

not disease specific
relieves symptoms i.e pain and fatigue
affirms life
regards dying as normal
integrates spiritual and psychological aspects into pt care
support system to help pt live actively until death
support system to help family live with illness and bereavement
team approach to address pt needs and their families
enhance QoL and influence course of illness

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7
Q

what is the role of RT

A

managing terminally ill pts

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8
Q

what are the general indicators of decline

A

decreased activity and function
increasing dependence in ADL
advanced disease - complex symptom burden
decreasing response
no further choice for active trt
progressive weightloss
repeated unplanned admissions
serum albumin <25g/l

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9
Q

how many pt are managed with a palliative intent

A

50%

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10
Q

whats the purpose of palliative care

A

symptom control
patient management
trt specific guidelines
pt and family have a shared understanding of aims

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11
Q

what does best interest mean

A

acting on behalf of someone who lacks capacity when making a decision based on past, present wishes, feelings, valued and consulting with others involved in their care

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12
Q

what is a declaration

A

formal statement by making a decision for someone else under MCA they have a duty to consider the best interests

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13
Q

what does declared to the family mean

A

advanced directive family is informed that the person lacks capacity

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14
Q

what is capacity

A

to make the right decision for themselves

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15
Q

what stage is palliative care appropriate for

A

any stage

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16
Q

what does palliative care focus on

A

relieving pain
reducing illness
related complications
enhancing QoL
prolonging life with trt like chemo and radiotherapy

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17
Q

what does palliative provide

A

medical supplies and other needed equipment, which is covered by medical insurance

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18
Q

what needs does palliative care meet

A

psychological and spiritual needs

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19
Q

what test can be done to see if there are brain meta

A

plain xray or MRI

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20
Q

what test can be done for hypercalcaemia

A

blood test

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21
Q

what are the implications for brain mets

A

intent becomes life limiting
primary disease management could change
serious change in prognosis

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22
Q

implications for hypercalcaemia

A

may be a result from bone mets

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23
Q

what do biphosphonates do

A

prevent osteoclasts from breaking down bone and releasing calcium into the blood

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24
Q

what does calcitonin do

A

stops the breakdown of bone and absorption in the blood

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25
what are brain met symptoms
persistent headache vomiting seizures confusion personality changes numbness in arms/legs speech difficulties
26
bone met symptoms
depression confusion memory loss fatigue/lethargy muscle weakness bone pain
27
what % of pt with advanced cancer experience pain
80 2/3 due to cancer 1/3 due to other causes
28
what is the RT for cranium
short fractionated dose dexamethasone = long course, high dose steroids
29
when should steroids be taken
in the morning to not impact sleep
30
corticosteroids SE
sleep issues mood changes indigestion weight gain thinning skin
31
what is classed as long term steroid use
> 3 months might carry a red steroid card around
32
what is a high dose of steroids
>6mg a day carry a blue steroid card
33
example of corticosteroids
dexamethasone
34
what can pain be classified as
acute chronic
35
what is pain
unpleasant sensory and emotional experience associated with actual or potential tissue damage
36
what should happen regarding pain before trt
pt should be informed on the need for analgesia, which is administrated based off the WHO pain ladder
37
what are the pain SE
nausea vomiting constipation pruritis (itching) dizziness dry mouth sedation
38
what is the pain associated with bone mets
some get relief 24hrs after trt (cytotoxic effect prevents the release of chemical medications of pain from normal cells) some experience a flare at 24 hrs
39
how long does RT pain control last
2-8 weeks as destroys some tumour cells at the deposit site DONT GIVE RT IF THEY WONT SURVIVE 2–8 WKS
40
what are the type of antiemetics
ondanestron levomepromazine metoclopramide
41
what are the side effects of ondansetron
constipation
42
what is the side effects of metoclopramide
colic diarrhoea
43
what line is levomepromazine
second line
44
side effects of levomepromazine
sedation, constipation, hypotension
45
what can we do to help with sickness
control malodour e.g colonstomy, fungating wound fresh air good oropharyngeal hygiene avoid emetogenic smells and foods avoid situations where nausea and vomiting responses are conditioned
46
management advice for constipation
fibre increased fluid intake exercise laxatives
47
what is constipation common with
opiates
48
what are the different types of laxatives
osmotic stimulant
49
what are osmotic laxatives
increases fluid in bowels softens stills and stimulates body to pass them
50
examples of osmotic laxatives
lactulose and macro gels
51
what are stimulant laxatives
stimulates muscles within the digestive tract lining
52
examples of stimulant laxatives
senna bisacodyl sodium picosulphate
53
what are the surgical procedures which can be carried out
pinning of pathological fractures toilet mastectomy debulking of lesions
54
what is debulking lesions for
ovarian cancer seedlings brain mets
55
who is toilet mastectomy for
locally advanced or met breast cancer
56
why is a toilet mastectomy done
to provide satisfactory relief from complications some symptoms might be distressing for the pt: - bleeding and secondary infections
57
what needs to be assessed for a toilet mastectomy
skin closure to see if a WLE is possible
58
what surgery should be avoided during a toilet mastectomy
axilla due to the lymphatics and brachial plexus present
59
what is a pathological fracture
a fracture caused by the disease itself
60
why does a fracture result in pain
the fracture reaches the perisoteum (outer bone edge, which means it’s hit a wall of nerves)
61
where is a pathological likely to be found
head/neck of femur long bone
62
what cancers are likely to result in bone mets
breast prostate lung colorectal
63
what is the appearance of a pathological fracture
moth eaten appearance s-shape tearing type stress fracture dark ring (radiolucent), lost bone density bone is all hollowed out
64
what is the aim of debulking lesions
to remove as much tumour as possible removal of cancer in specific locations i.e causing bowel obstruction improves patient nutritional and immunological needs
65
why is it good debulking lesions
removing large necrotic masses promotes drug delivery to smaller tumours with a good blood supply smaller tumours have a high growth fraction that should be more chemo sensitive
66
what is the % of ovarian cancer which presents at III or VI
60-70%
67
where does ovarian cancer spread..
throughout the abdomen
68
what is the aim of debulking ovarian cancer
leave no tumours behind no larger than 1cm = optimally debulked
69
what is a sub optimal debulk
when tumours are left which are greater than 1cm
70
what can ovarian seedlings lead to
ascites (fluid caused by the immune response)
71
what is a craniotomy
removal of portion of the skull
72
what is brain met surgery best for
single met lesion in a well controlled systemic cancer
73
what are surgical risks for brain mets
neurological deficits infections bleeding surgery near the optic nerve causes vision loss
74
what is hormone therapy mainly for
breast and prostate
75
what is given for hormone therapy
corticosteroids
76
examples of corticosteroids
dexamethasone, prednisone, prednisolone, hydrocortisone
77
what are the acute risks of corticosteroids
dyspepsia peptic ulcer disease insomnia oral + vaginal candidiasis anxiety glucose intolerance
78
what are the chronic risks of corticosteroids
develop cushingoid appearance weight gain oedema cataracts osteoporosis proximal myopathy skin thinning infection impaired wound healing neuropsychiatric changes: depression, agitation, delirium
79
when is hormone therapy most beneficial for breast pts
post menopausal, disease free for 2 years
80
what is tamoxifen
anti oestrogen (antagonist) similar properties to oestrogen
81
how does tamoxifen work
prevents hormone receptors from being activated
82
what is breast cancer stimulated by
circulating oestrogens
83
side effects of tamoxifen
hot flushes: airy clothes feeling sick/vomiting: simple and bland foods headache: pain killers light headed/dizzy: don’t drive or use machinery genital itching, menstrual changes, pain
84
what are the two types of aromatase inhibitors
anastazole letrazole
85
what does anastazole do
blocks aromatase enzymes which are involved in oestrogen production in the body. decreases tumour size or delays progression
86
what does letrazole do
inhibits the enzyme in the adrenal glands (aromatase) which produces oestrogen, oestrodiol and oestrone
87
what progesterone drug can be given
megestrol acetate MEGACE = second line normally if everything else has failed mostly benefits pt who’s post menopausal and disease free for two years
88
how does hormone therapy work for prostate cancer
stop testosterone from being produced, reaching prostate cells which rely on testosterone to grow
89
what does hormone therapy do for prostate cancer
causes the cancer cells to die or grow more slowly
90
side effects of HT for prostate cancer
loss of muscle mass Increased body fat Erectile dysfunction Loss of sex drive Bone thinning which leads to broken bones Hot flushes Fatigue Behaviour changes metabolism changes decreased body hair, smaller genitalia, growth of breast tissue
91
where is testosterone produced
testes adrenal glands
92
what do androgens do for men
control development and maintenance of male characteristics, promote growth of normal and cancerous cells by binding to and activating the androgen receptors
93
what happens when the androgen receptors are activated by proteins
stimulates the expression of specific genes which cause prostate cells to grow
94
what proteins stimulate the androgen receptors
testosterone dihydrotestosterone
95
why is an orchidectomy good
reduces circulation of androgens by 90% as some is released in the adrenal glands
96
how many pt with advanced prostate cancer respond to surgical castration leading to reduced testosterone
80%
97
how long does the immediate effect last regarding an orchidectomy
up to 2 years
98
what is the median response for an orchidectomy
18-24 months
99
when is an orchidectomy done
for primary and met spread
100
what is a medical castration
LHRH agonists prevent pituitary gland from secreting LH, which is similar structurally to LHRH which binds to the receptor
101
describe what happens when androgen levels are low
when androgen levels are low the hypothalamus releases LHRH stimulates the pituitary to produce LH which stimulates testicles to produce androgens
102
what happens when LHRH agonist is given
initially stimulates LH causing more testosterone to be produced after first injection - a flare continued high levels of agonists causes pituitary gland to stop producing LH, testicles are not stimulated to produce androgens
103
what happens if they stop taking the agonist
production of LH resumes and androgens are produced
104
what are the agonists which can be taken
zoladex, prostap, lupron injection or implanted under skin
105
what are the type of anti androgen tablets which can be taken
bicalutamide cyproterone flutamide
106
what do the anti androgen tablets do
stop testosterone from reaching the cancer cells, less likely to cause a sexual issue + bone thinning but more likely to cause breast swelling, tenderness and liver problems
107
what does the androgen deprivation therapy and docetaxel do
extends life (palliative care)
108
who receives ADT and docetaxel
pt with advanced disease and good condition SE can be difficult to manage
109
what hormones do endometrial cancer tend to use
progesterone progesterine
110
why is progesterone good for endometrial cancer
slow growth of endometrial cells useful for pt that want to get pregnant
111
SE for progesterone/progesterine
hot flushes weight gain (high fluid retention, increased appetite) night sweats worsening depression increased blood sugar levels with diabetes serious blood clots (rare)
112
what type of progesterone therapy can be given for endometrial
megestrol acetate (capsule or liquid) medroxyprogesterone (pill or injection)
113
when are aromatase inhibitors given for endometrial pts
after ovaries removed or aren’t functioning
114
where is oestrogen made if not in ovaries
fat tissue
115
what do aromatase inhibitors do for endometrial cancer
stop oestrogen from being made given if pts can’t have surgery
116
what are the type of aromatase inhibitors given for endometrial pts
letrazole anastrozole etremstane
117
what are the side effects to aromatase inhibitors for endometrial
headaches joint pain hot flushes oestoporosis
118
when is tamoxifen given for endometrial cancer
advanced or recurrent
119
what is better tolerated for endo than progesterone alone
tamoxifen and progesterone alternate
120
what is the goal of tamoxifen
prevent oestrogen from encourage cell growth of cancer
121
SE of tamoxifen for endo
hot flushes vaginal dryness high risk of blood clots in legs DOESNT CAUSE BONE LOSS

Complex Issues in Radiotherapy (12 decks)

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