By Dr. D. Narinesingh and team Presented by Nazreen Bhim

 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

 Age  Social/Family Support  Patient and Relatives wishes  Performance Status  Prognosis  Suitability for active intervention

 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 infusion Palliative RT to bone mets. Morphine SR orally for pain control Therapeutic Paracentesis and Blood transfusions

 95 y.o female  Ovarian CA- Stage III diagnosed in 2010  Had 6 cycles Carboplatin/Taxol > Maintence Femara>Cyclophosphamide> Progression  Main Complaints: Distended Abdomen (2 0 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 tolerable Therapeutic Paracentesis

 KS, 24yo Male  Diagnosed with Rectal CA with multiple liver metastases in October 2011  Had 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

 AB 29 yo female  Gastric CA with Bone Metastases  Diagnosed during pregnancy  Severe pancytopenia  PS=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 chemotherapy Morphine sc infusion (100mg in 1L N/S over 24h) IVF sc (with Valium and Haloperidol) Blood transfusions, then haematinics

 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 2 0 ingestion of 40 Morphine 60mg tabs