by dr. d. narinesingh and team presented by nazreen bhim
TRANSCRIPT
PALLIATIVE CARE AT SFGH-
A CASE SERIESBy Dr. D. Narinesingh and team
Presented by Nazreen Bhim
DEFINITION Palliative care is an approach that
improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems: physical, psychosocial and spiritual.
Palliative
Care
Integrates the psychological and spiritual aspects of
patient care
Intends neither to hasten or postpone
death
Offers a support system to help the family cope during the patients illness
and in their own bereavement
Is applicable early in the course of
illness, in conjunction with other therapies
that are intended to prolong life
Relief from pain and
other distressing symptoms
Will enhance quality of life, and may also
positively influence the
course of illness
CONSIDERATIONS Age Social/Family Support Patient and Relatives wishes Performance Status Prognosis Suitability for active intervention
CASE 1 JR 63yo female Diagnosed with Left Breast CA in 2005/2006
Post Lt MRM & ALND Post adjuvant Chemo-RT Triple Negative PS=4
CT Scan Abd/Pelvis: Widespread bone metastases Ascites and pleural effusions Bilateral hydronephrosis of indeterminate etiology
Admitted repeatedly for abdominal distension and anaemia
Palliative
Care
Supportive care
Patient and relatives
counselled regarding prognosis
Patient referred to Palliative
care Clinic and Oncology counsellor
Zoledronic acid infusionPalliative RT
to bone mets.
Morphine SR orally for pain control
Therapeutic Paracentesis and Blood transfusions
CASE 2 95 y.o female Ovarian CA- Stage III diagnosed in 2010 Had 6 cycles Carboplatin/Taxol >
Maintence Femara>Cyclophosphamide> Progression
Main Complaints: Distended Abdomen (20 ascites)
PS =2
Palliative
Care
Supportive care
Patient and relatives
counselled regarding prognosis
Patient referred to Palliative
care Clinic and Oncology counsellor
Avastin +
Femara
Pain tolerabl
e
Therapeutic
Paracentesis
CASE 3 KS, 24yo Male Diagnosed with Rectal CA with multiple liver
metastases in October 2011Had Xeloda x 3cycles then, CEA↑ and ↑in size of
rectal lesion, Pt counselled on starting XelOx (PS=2)
Patient presented for review and admitted non-compliance to Xeloda and agreed to start Rx.
After Xeloda x3cycles Pt diagnosed with DVT.Hb <6. (PS=4)
Palliative
Care
Supportive care
Patient and relatives
counselled regarding prognosis
Patient referred to Palliative
care Clinic and Oncology counsellor
Palliative RT + Chemotherapy
Clexane injections
Morphine SR orally +
Morphine sc injections prn
Blood Transfusions + Wound
care
CASE 4 AB 29 yo female Gastric CA with Bone Metastases
Diagnosed during pregnancySevere pancytopeniaPS=4
Had 3cycles of weekly 5FU/LV (discontinued due to very difficult IVA and pt not stable enough for CVP line/Port insertion) and Xeloda x2cycles
Admitted to ward for severe anaemia (Hb=2.3), and UGIB
Palliative
Care
Supportive care
Patient and relatives
counselled regarding prognosis
Seen as in patient by
Palliative Care Specialist and
Oncology counsellor
Palliative chemoth
erapy
Morphine sc infusion
(100mg in 1L N/S over 24h)
IVF sc (with Valium and Haloperidol)
Blood transfusion
s, then haematinics
CLINICAL SCENARIO 73 yo male Pancreatic CA Stage 4 (newly
diagnosed) PS=4 Admitted for UGIB and discharge to PCC
as outpatient on Morphine SR 60mg po bd
Presented to resus room A+E 2/7 later with unresponsiveness 20 ingestion of 40 Morphine 60mg tabs