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