PALLIATIVE CARE 2: PALLIATIVE CARE BASED ON EBM

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Abstract

(1) Palliative care: Providing palliative care from the early stage of cancer is indicated to be effective. (2) Pain management according to the ‘Clinical Guidelines for Cancer Pain Management’: (i) assessment: pain is a subjective symptom. Pain should be evaluated by patient's expression in its intensity, quality and the level of impairment on quality of life. (ii) Classification: pain is classified into visceral pain, somatic pain and neuropathic pain. Appropriate assessment leads to proper management of pain. (iii) The WHO method for cancer pain relief: analgesics should be chosen according to the severity of the pain, complications and possible route of administration. (iv) Opioid rotation: switching opioid enhances the analgesic effect and avoids side-effects. Understanding the characteristics of each opioid is important to make appropriate choice of opioid. (v) Neuropathic pain (NP): NP is characterized as burning pain, lancinating pain, paresthesia, hyperalgesia and/or allodynia. Using opioids, NSAIDs, analgesics adjuvants (antidepressants, anticonvulsants, antiarrhythmic drugs, antagonists NMDA (N-methyl-D-aspartate receptor)) in combination is recommended for the management of NP. (3) Dyspnea management according to the ‘Clinical Guidelines for Respiratory Symptoms in Cancer Patients': (i) definition: dyspnea is defined as ‘an uncomfortable sensation of breathing’. It is not always correlated with respiratory failure (=hypoxemia). (ii) Symptomatic treatment: systematic reviews showed morphine alleviate dyspnea in cancer patients. The effectiveness of oxicodone and fentanil has not yet been reported. Anti-anxiety drug and corticosteroids may be suggested. (4) Sedation according to the ‘Clinical Guideline for Palliative Sedation Therapy’: Sedation may be recommended in case of refractory sufferings in terminal stage. Palliative prognostic index is widely used as a screening tool to predict death within 3 weeks.

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