Palliation of Patients with Incurable Cancer - Essay Example

Palliation of Patients with Incurable Cancer By [author] [student ID no.] [subject] [professor] [date] Palliation of Patients with Incurable Cancer I. Introduction Cancer is a group of more than 100 diseases characterized by the abnormal growth of cells which have distinctively uncontrollable metastasis. Cancer is a malignant form of cancer that can affect different parts of the bodily organs and tissues and is often times, named by the origin of the tumour (MedicineNet 2008). Researches and the introduction of new techniques and technologies to oncology over the last few decades have catapulted to the increase in the quality of medical treatment of cancer. Moreover, it has also opened a variety of options for the patient in terms of choices for curative and palliative treatment. Conventional and complementary treatments may be used and these may be delivered by the public (e.g. NHS) and private healthcare systems in the United Kingdom of Great Britain. The basic assumption is that the current trend for oncology-related techniques have reduced the mortality and fatality cases of cancer patients over the past decades but still there are those case wherein therapy is unlikely to cure their terminal ailment or the gravity of their cancer stage. Herein, we discard all summary investigation regarding therapeutic treatment of carcinoma but rather focus on the aspects of palliative treatment using symptomal, therapy-associated, and complementary medicine as well as to investigate the psychological and social aspects surrounding the terminal stage of disease. Corollary to this is the examination on the expansive role or the new evolving role of the practitioner or the medical team in giving medical assistance to the patient. An overview of the patient’s cognitive and medical responses is also included. II. Cancer’s Last Stage and Palliation Cancer, as characterized by abnormal cell metastasis and subsequent invasion to the other cells, follows a certain progression or stages. Cancer is strongly influenced by genetic factors —development of the oncogenes and malfunctioning of the tumour suppressor genes— although, the environment can also serve as determinant of the disease (MedicineNet, 2008). There are four general stages of cancer; each stage is denoted by a Roman numeric (Stage I-Stage IV). Cancer progression can be described as follows: Stage 1 is denoted by initial carcinoma in the tissue or the organ followed by enlargement in Stage II, and spread to lymphodes (or lymphonoma) in the Stage III which ultimately progresses to the worst stage, characterized by the spread to other organs of the body (MedicineNet, 2008). Stage IV cancer cannot be sometimes treated and it is in this stage wherein palliation is recommended as a medic response to terminal illness. Palliation, as opposed to the curative paradigm approach, is a care-based system exploring different alternatives and therapies for the main purpose of alleviating or improving quality of health of a particular patient during his/her last stage of his/her life (Brenner 1999). Palliation takes on a more humanistic approach with general consideration of cultural practices, psychological and social aspects of the patient’s life through assisted care from the specialist, general practitioner, hospice, relatives and friends. Palliation includes many forms including III. Symptom Control in Dying Perhaps the most basic approach to palliative care in cancer-related terminal illness is symptom control for physical and mental distress. Symptom control allows the patients to focus more on the aesthetic qualities of life and in considering symptom control, the use of medicines should always be based on etiology. Pain is a commonly manifested in more than 50% of the terminal-case patients and drug administration is dependent on the pain intensity and the cause. Pain relievers and analgesics at sufficient dosage can cause the sedation or confusion. Drug treatments vary for mild pain— aspirin, acetaminophen, or NSAIDs; for moderate pain— codeine or oxycodone (e.g. Oxycontin, Oxyir); and for severe pain—hydromorphone (e.g. Dilaudid), morphine (e.g Avinza, Depodur, Kadian) or fentanyl (e.g. Actiq, Duregesic). Opioid administration can be oral, intravenous (IV) intramuscular (IM), or rectal with first-mentioned as the most common and convenient. Associated effects also include nausea, repiratory depression, constipation (prophylactic treatment), myoclonus, delirium, and hyperalgalsia. Use of adjuncts like corticosteroids, tricyclic antidepressants, Doxepin, Gabapentin, methadone and Benzodiazepines allows reduction of opioid effects, reduction of neuropathic pain and anxiety relief. Indwelling epidural or intrathecal catheters are anaesthesiologic techniques that provide for continuous flow of analgesics and drugs (2008 Merck). Dyspnea or breathlessness can be relieved by oxygenation through the nasal cannula; morphine administered sublingual ( 2-10 mg) for blunt medullary response to oxygen decline; and airway congestion treated with drugs for secretion drying (e.g. benadryl 10-50 mg IM 4 to 6 hr prn) and/or nebulized saline(2008 Merck). Appetite stimulants like dexamethasone, prednisone, and megestrol can be administered orally to the anorexic patients and artificial feeding (e.g. IV fluids and TPN) is not generally recommended since they aggravate discomfort and may hasten patient death. Xerostomia and dehydration related-anorexia can be treated using oral swabs or ice chips (2008 Merck). If cause for nausea and vomiting is unidentified, phenothiazine can serve as a non-specific treatment and anticholinergic drugs like scopolamine and antihistamine to prevent recurrence. If cause is identified then the following treatments are possible: H2 blockers (gastritis), cortiosteroids (brain metasteses), metoclopromide (gastric distention or reflux), 5 HT3 anatgonists ondasetron and gansetron ( chemotherapy-induced), and antiemetics( severe cases) (2008 Merck). Constipation can be treated using laxatives (e.g. casanthranol) and stool softeners (e.g. docusate). Pressure ulcers can be treated with rotation, air suspension, and an indwelling catheter. Confusion is common in terminal case patients are most often times induced by medications. In cases wherein agitation is present, barbiturates like short-acting Pentobarbital and long acting Phenobarbital can be prescribed to the patient. Depression symptoms are very common in dying patients and the most common approaches are psychological and/or drug therapy using anti-depressants (e.g. methylphenidate) (2008 Merck). Stress and grief are treated can be treated with psychotherapy. III. Palliation and Complementary and Alternative Medicine Alternative and complementary medical systems can also be used for palliative care and, within this concept, culture integration is prevalent and highly obvious. Verily it is up to the patient to choose what type of palliative methods to treat his/her terminal afflictions. Alternative types include the Indian Ayurveda , Germans’ homeopathy, US’ naturopathy, and the Chinese’ acupuncture. Ayurveda’s concept is based on the principle that disease uprooted from imbalance between vata, pita, and kapha and can be corrected with yoga, herbs and massage. Homeopathy makes use of the diluted disease. Naturopathy is based on the concept of natural body healing achieved through a healthy lifestyle. It is more of a combination of healthy therapies including guided imagery and other alternatives. Acupuncture is the specific stimulation of nerves in the body using thin needle insertions (2008 Merck). Biologically based treatments includes practices which dabble into naturally-occuring substances, herbs and orthomolecular or megavitamin therapies. On the other hand, energy therapies makes use of magnets or any device that would channel energy biofields in a specific location in the body. Magnets are often used to alleviate muskoskeletal conditions. Manipulative and body-based methods includes chriropactic and body massage wherein general relief is brought to the body by the structure of the spine and the NS. Massage is used to brought relief to the body by reducing pain and stress (2008 Merck). Mind-body techniques are used for psychological and behavioral palliations and techniques include imagery, hypnosis, meditation, and relaxation. Biofeedbacks used electronic devises to specifically target information based on bodily function whereas hypnotherapy is used for advanced state of relaxation (2008 Merck). Although alternative and complementary studies have not been yet proven by clinical studies to play a significant role in combating cancer, their roles in palliation cannot be contended, most especially if the conventional therapies prove to be ineffective for treating the patient’s cancer. Psychologic-related therapies may prove to be helpful for the patient to overcome his/her grief during terminal illness (2008 Merck). IV. Advanced-Therapy Associated Palliation Conventional therapies are also used in palliative care and amongst the most common conventional therapies used in palliations are surgery, hormone, chemo- and radiotherapy. Surgeries are performed to reduce the size of tumors. Hormone therapy is used for the suppression of the testosterone hormone thus decreasing or slowing down tumor growth. Radiotherapy is highly lethal to cancer cells (2007 UK Healthcare) but in the case of palliation, the beam technology is used mainly used to target the specific bulk of cells for the primary objective of reduced tumor size which causes invariable pressure. Apoptopic death is said to be more effective if combined with vitamin therapy (2004 Advanced Cancer). Chemotherapy is rarely used in palliation (except in cases where there is failure in hormonal therapy). Apoptopic death is induced by exposure to chemical reagents. However in the case of multiple myeloma in bone marrow cancer patients, thalidomides have been shown to be effective for palliative conditions during the advanced stage. Antineoplastons are also used to treat advanced stages of head and neck cancers (2004 Advanced Cancer). Moreover, administration of cure for patients with advanced cancer can be made easier by using DNA microarray chips to detect the gene responses of patients to different drugs and can thus diagnosed their conditions based on the results (2007 News Medical Net). V. Role of Medical Practitioners and Teamwork in Palliation Central to palliative care for terminal cases is the harmonious delivery of the quality cares my medical practitioners and their teamwork capacity. There are two modicums for palliation during life-endpoints and that is within hospices and home-based facilities which are delivered by the practitioners. Practitioners involved are the specialized oncologist team, the general practitioner, private care-givers, and nurses. The initial role is assisting the patient in making him/her realized that he/she has reached the terminal case for carcinoma and that he/she must accept the fact wholeheartedly and not morosely. Their roles also expand to suggesting economic palliative techniques and providing quality during the terminal life of the patient. VI. Conclusion Palliation in terminal or advanced medicine necessitates more than bodily therapies for improvement of the end-life quality of the patient; it also involves recognition of social factors which is seen in the case of medical practitioners, relatives and friends. Bibliography Advanced Cancer (2004). Advanced Cancer [Internet]. Available from: Advanced Cancer Database [Accessed February 14, 2008]. Complementary and Alternative Medicine. (2008). Merck and Co. Inc. Available from: Merck Manuals Database [Accessed February 14, 2008] Brenner, M. (1999). The Curative Paradigm in Medical Education: Striking a Balance Between Caring and Curing. In: The Pharos, 1999, 6pp. Bucci, M. K, A. Bevan, and M. Roach. (2005). Advances in Cancer Therapy.. In: CA: Cancer J. Clin. ,55:117-134. Cancer. (2008). MedicineNet. Available from: Medicinenet.com [Accessed February 11, 2008]. DNA microarray chips improved therapy in some patients with incurable cancer. (2007). News-Medical Net. [Internet]. Available from: http://www.aacr.org/ [Accessed February 14, 2008]. Radiation Therapy. (2007). UK Healthcare. [Internet]. Available from: University of Kentucky Database [Accessed February 11, 2008]. Symptom Control. (2008). Merck and Co. Inc. Available from: Merck Manuals Database [Accessed February 14, 2008] Read More