ROLE OF PALLIATIVE PHYSCIAN IN CANCER PATIENTS

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ROLE OF PALLIATIVE PHYSCIAN IN CANCER PATIENTS:

ROLE OF PALLIATIVE PHYSCIAN IN CANCER PATIENTS First modern hospice in London -1967 DAME CECILY SAUNDERS DR.S.SREENIVASARAO MD,C.C.P.P.M , ASSIST PROFESSOR, DEPT.OF ANAESTHESIA, S.V.R.R.G.G.H.&S.V.M.C,TIRUPATI

Slide 2:

HAMAN LIFE-DOCTOR OBSTRITICIAN PHYSCIAN BIRTH DEATH PAEDIATRICIAN PHYSCIAN PAEDIATRICIAN ------------ O B S T R I T I C I A N------------------------ SURGEON & PHYSCIAN---------------------------- ---------------------------------- PALLIATIVE PHYSCIAN OBSTRITICIAN PHYSCIAN BIRTH DEATH PAEDIATRICIAN PHYSCIAN

PALLIATIVE PHYSCIAN:

PALLIATIVE PHYSCIAN WHEN THE SPECIALIST SAYS ADVANCED DISEASE NO USE OF CHEMOTHERAPY NO USE OF RADIOTHERAPY CAN’T DO SURGERY BUT PATIENT HAD SO MANY PROBLEMS DUE TO DISEASE & DUE TO THERAPIES CARE BEYOND CURE

Slide 4:

The worst thing to say, is : “ there is nothing more we can do for you , you can take her home now ”

When should Palliative Care begin ?:

When should Palliative Care begin ? Anti Cancer Treatment Pain Relief and Palliative Care Death Pain Relief and Palliative Care At the time of diagnosis Death Anti Cancer Treatment Pain Relief and Palliative Care Bereavement Support Bereavement Support Anti cancer treatment Pre-diagnosis

:

Total Suffering Pain Other Physical Symptoms Spiritual Cultural Social Psychological Financial Emotional We have to relieve all aspects of suffering

Slide 7:

Definition of Palliative Care : (WHO 2002) Palliative Care is an approach that Improves the quality of life of patients and their families facing the problem associated with life-threatening and chronic illnesses, through 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 IS……………:

PALLIATIVE CARE IS…………… PATIENT –CENTRED RATHER THAN DISEASE –FOCUSED DEATH ACCEPTING BUT ALSO LIFE ENHANCING A PATNERSHIP BETWEEN THE PATIENT AND THE CARERS CONCERNED WITH HEALING RATHER THAN CURING LOW TECH AND HIGH TOUCH

COMMON SYMPTOMS IN CANCER PATIENTS:

COMMON SYMPTOMS IN CANCER PATIENTS SYMPTOMS MAY BE DUE TO CANCER ITSELF THERAPEUTIC INDUCED

SYMPTOMS CONT………….:

SYMPTOMS CONT…………. CANCER PAIN ALIMENTARY SYMPTOMS ANOREXIA NAUSEA&VOMITING CACHEXIA CONSTIPATION DYSPEPSIA GASTRIC STASIS GASTRIC OUTFLOW OBSTRUCTION OBSTRUCTION

SYMPTIMS COMT……………:

SYMPTIMS COMT…………… RESPIRATORY SYMPTOMS BREATHLESSNESS ACUTE TRACHEAL COMPRESSION MASSIVE HAEMORRHAGE IN TO TRACHEA HICCUP DEATH RATTLE CHEST PAIN MUCOSITIS ASPIRATION

SYMPTOMS CONT…………..:

SYMPTOMS CONT………….. URINARY SYMPTOMS FREQUENCY URGENCY URGE INCONTINENCE DETROSSOR INSTABILITY STRESS INCONTINENCE DYSURIA HESITANCY URINARY BLADDER SYMPTOMS RATENTION &BLADDER SPASMS

SYMPTOMS CONT……………:

SYMPTOMS CONT…………… OTHERS ASCITES HYPERCALCEMIA SPINALCORDCOMPRESSION LYMPHOEDEMA PRURITIS SEC. MENTAL DISORDERS DELERIUM&DEMENTIA AMNESTIC DISORDERS ANXIETY DISORDERS MOOD DISORDERS PERSONALITY DISORDERS PSYCHOSIS

LYMPHOEDEMA:

LYMPHOEDEMA

LYMPHOEDEMA:

LYMPHOEDEMA LYMPHATIC SYSTEM IS THE CONTROLE OF ECF VOLUME AND CONTENT—IT IS THE SAFETY VALVE FOR THE PREVENTION OF ANY OEDEMA IF THE BALANCE BETWEEN CAPILLARY FILTRATION AND LYMPH DRAINAGE ALTERS LYMPH STAGNATES IN TISSUES LEADS TO LYMPHOEDEMA TISSUE SWELLING DUE TO A FAILURE OF LYMPH DRAINAGE

TYPES:

TYPES PRIMARY CONGENITAL POSTPUBERTAL SECONDARY CANCER & ITS TREATMENT INFECTION

PATHOGENESIS IN CANCER &ITS TREATMENT:

PATHOGENESIS IN CANCER &ITS TREATMENT USUALLY SEEN AFTER SURGERY & RADIOTHERAPY IN SURGERY DISSECTION OF LYMPHATICS IN RADIOTHERAPY POSTRADIATION FIBROSIS OF NODES DAMAGE THE MECHANISM THAT CONTROLE ITRINSIC RHYTHEMIC CONTRACTILITY OF LYMPH VESSELS IRRADIATION MAY INHIBIT THE CELL DIVISION NECESSARY FOR THEIR REGENERATION INCREASE THE GENERAL FIBROSIS IN THE OPERATED WOUND &CREATES A MECHANICAL BARRIER TO THOSE LYMPHATICS STILL CAPABLE OF REGENERATION CANCER ITSELF BLOCK THE LYMPHATICS

LYMPHOEDEMA CAUSES:

LYMPHOEDEMA CAUSES SWELLING CELLULITIS FIBROSIS TUMOURS

DIAGNOSED BY:

DIAGNOSED BY HISTORY CLINICAL EXAMINATION INVESTIGATION Lymphangiography Radionuclide lymphoscintigraphy Gadolinium enhanced magnetic resonance scans (MRI

AIM OF TREATMENT:

AIM OF TREATMENT TO IMPROVE QUALITY OFLIFE Lymphoedema cannot be cured, but it can be controlled Treatment for lymphoedema needs to be intensive and lifelong

GUIDE TO THE SELECTION OF TRAETMENT:

GUIDE TO THE SELECTION OF TRAETMENT ESTABLISH THE CAUSE AND TYPE OF OEDEMA CONSIDER THE PATIENT’S CIRCUMSTANCES CONSIDER THE PATIENT’S WISHES ESTABLISH THE LIKELY OUTCOME OF TREATMENT

Management:

Management Prevention Explanation Setting up a realistic expectation General Measures Drugs Surgery Specific Treatment

Serial Measurement:

Serial Measurement

Measurement:

Measurement

Drugs:

Drugs Pain management Diuretics- if venous edema (limited role) Steroid- if tumor obstruction Antibiotics- Infection

Surgery:

Surgery Limited role Lymphovenous shunt Reconstruction surgery- Healing difficult

Specific Management:

Specific Management Skin Care Exercise Massage Containment

Skin Care:

Skin Care Injury- Infection- Scar- Lymphatic obstruction- More edema Avoid tight garments and jewellary Avoid cut and abrasions Avoid intravenous canulation and BP measurement Inform doctor if notice any signs of inflammation

Exercise:

Exercise Stimulate the flow of Lymphatics by muscle pumping (blood flows by heart pumping) Mobility to the joint to prevent contracture

Exercise:

Exercise

Massage and manual lymphatic drainage (MLD) :

Massage and manual lymphatic drainage (MLD) To stimulate and drainage of normal lymphatics

Containment:

Containment Bandaging- Moderate to severe edema, uneven surface Preformed sleeves and stockings- Even arm, mild to moderate edema Compression hosiery

Containment:

Containment

Sleeves:

Sleeves

Total Care:

Total Care