Sarcoma Exchange 2018 Sarcoma Alliance Palliative Care Sarcoma Exchange 2018 Sarcoma Alliance

Objectives To understand: What is Palliative Care? Who provides Palliative Care? Is Palliative Care right for me? How can Palliative Care help me? Brief Overview of Symptom Management

What is Palliative Care? Palliative care is specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.

You Are a Bridge https://youtu.be/lDHhg76tMHc Center to Advance Palliative Care: GetPalliativeCare.org This Photo by Unknown Author is licensed under CC BY-SA

Who provides Palliative Care? Palliative care is provided by a specially trained team of doctors, nurses, and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.

Palliative Care Multidisciplinary Team Doctors Nurses Social Workers Chaplains Mental Health Professionals Physical Therapists/Occupational Therapists Pharmacists Dieticians

The Most Important Members of the Team YOU YOUR LOVED ONES / CAREGIVERS

Is Palliative Care Right for You? From CAPC website Do you have one or more serious illnesses such as: Cancer Congestive heart failure (CHF) Chronic obstructive pulmonary disease (COPD), emphysema, lung disease Kidney failure Liver failure Neurological diseases (e.g., ALS, Parkinson's) Dementia

Do you have symptoms that make it difficult to be as active as you would like to be, or impact your quality of life? These symptoms might include: Pain or discomfort Shortness of breath Fatigue Anxiety Depression Lack of appetite Nausea Constipation

Have you, or someone close to you, experienced the following: Difficult side effects from treatment Eating problems due to a serious illness Frequent emergency room visits Three or more admissions to the hospital within 12 months, and with the same symptoms

Do you, or someone close to you, need help with: Knowing what to expect Knowing what programs and resources are available Making medical decisions about treatment choices/options Matching your goals and values to your medical care Understanding the pros and cons (benefits/burdens) of treatments (e.g., dialysis, additional cancer treatments, surgery, etc.)

Do you, or someone close to you, need help with: Coping with the stress of a serious illness Emotional support Spiritual or religious support Talking with your family about your illness and what is important to you

If you answered YES to any of the above questions You could benefit from a Palliative Care consultation Ask you Oncologist or Primary Care Provider for a referral

How Can Palliative Care Help Me? Reduce burden of troublesome symptoms Address complex psycho/social/spiritual issues Improve Quality of Life Empower individuals and encourage informed decision making Provide support/resources to loved ones and caregivers

Additional Potential Benefits Reduce ER (emergency room) visits Reduce length of stay and frequency in the hospital Fewer ICU ( intensive care unit) admissions

Patient Centered Symptom Assessment Physical Assessment Illness and treatment history Symptom and functional assessment Psychological Assessment Fears and emotional response to illness Mood and coping skills Unresolved issues and Cultural beliefs Social Factors Caregiver, domestic needs and financial resources Spiritual Needs Religion Personal meaning in a larger context

Management of Pain Pharmacologic Nonpharmacologic Tylenol NSAIDS Opioids Nonopioid/Adjuvant medications: Tricyclic Antidepressants, Anticonvulsants, Steroids Nonpharmacologic Anesthesia procedures: Nerve block Radiation therapy Physical therapy Cognitive therapy Acupuncture, massage, use of heat/cold Prayer, meditation, music

Management of Constipation Prevention is key What is the cause of the constipation? Low intake of fluid/fiber Impaired mobility Underlying disease Medications “Smush and Push”

Management of Nausea/Vomiting Multi-factorial/Attempt to define underlying cause Physiological: Gastrointestinal, Metabolic, Central Nervous System, Vestibular Psychological: Emotional factors Medications Treat underlying cause Non-drug intervention Small frequent meals Avoid foods with offensive flavors/odors Avoid dairy/dairy products

Management of Shortness of Breath Address the underlying cause Oxygen if warranted Medications Bronchodilators Opioids-morphine Corticosteroid Mucolytics Anxiolytics Anticholinergics

Management of Shortness of Breath: Part 2 Non-drug measures Positioning Bedside fan Air conditioning Optimize air circulation-open room, open windows Relaxation techniques Cognitive behavioral therapy Pursed lip breathing Energy conservation techniques

Management of Fatigue Prioritize activities Frequent rest periods Energy conservation Physical therapy/Occupational therapy Assistive devices as needed: walker, wheelchair Optimize diet Optimize sleep at night Treat insomnia Treat anemia as needed

Management of Anxiety/Depression Multifactorial Assessment of physiological causes contributing to this Mental health provider, Social worker, Chaplain support Psychotherapy/Counseling Cognitive behavioral therapy Cultural considerations Medications

Resources for Further Information Cancer Survivors Network-American Cancer Society: https://csn.cancer.org/ CancerCare: Counseling. Support Groups. Education. Financial Assistance. https://www.cancercare.org/ Center to Advance Palliative Care: GetPalliativeCare.org

Questions? Comments? Concerns?

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