EndofLifeCare-PublicHealthandSocialJustice.ppt

Dyspnea 70% of CA patients, survival 12 weeks. Clinical assessment is poor as the symptom of breathlessness is poorly correlated with hypoxia or tachypnea. Am J Hosp Palliat Care 2000, 17:259-264. 20% obtain relief with O2, broncho-dilators, parenteral opiates, anxietyolytics. Cancer 1996;78:1314-9. To O2 or not to O2? All pts improved with either intervention, hypoxic pts did not have greater improvement even if O2 sat corrected! J Pain Sympt Manage?2006;32:541-50. RCT, double blind, dyspneic CA, N=51, O2 by prongs v air. Bronchial Secretions Bronchial secretions in 41% Oral/bronchial suctioning with distress in 9% Severe bronchial secretions in 4%. Etiologies of bronchial secretions: Primary lung CA, pneumonia, and dysphagia. No significant effects of severity of peripheral edema or pleural effusion on incidence or severity of bronchial secretions. J Pain Sympt Manag?2004;27:533-9. (Japan) Multicenter, prospective, observational study, regression analysis, 310 patients in last three weeks of life. Terminal Breathing Anomalies Noisy Breathing: “Death rattle” Scopolamine Benadryl Cheynes-Stokes (periodic) breathing Prospective family counseling to reassure that this is not dyspnea. These distress caregivers: EDUCATE! Routine Hydration: Not Indicated Hydration group (n=59):1 L or more IV per day, 1 and 3 weeks before death. Non-hydration group (n=167). ? edema (44 v 29% .04), ? ascites (29 v 8%, .001) and ? pleural effusion (15 v 5%, .016) in hydration group. No differences in bronchial secretion, hyperactive delirium, communication capacity, myoclonus or bedsores. Multi-center, prospective, observational study, 226 terminally ill patients with less than 3 weeks to live with abdominal CA. Ann Onc 2005;16:640-7. (Japan) Similar to Supp Care CA 2001;9:408-19. Terminal Fluids Dry mouth with stomatitis, oral breathing, opioids is ‘read’ as thirst but not amenable to fluids. Supp Care Cancer 2001;9:177-86. Education of family re goals/effects is critical.