By Marie Fallon, Geoffrey Hanks
This fresh version of ABC of Palliative Care pulls jointly the main updated info in this complicated, multidisciplinary zone in a pragmatic, effortless demeanour. totally up to date, it bargains with the vital social and mental points for palliative care of individuals with incurable illnesses together with caliber of existence, verbal exchange and bereavement issues.
This authoritative, functional identify should be worthy to the expanding numbers of medical professionals, senior and expert nurses, and all these health and wellbeing execs who take care of melanoma sufferers in the health facility, at domestic or in a hospice.
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The antiemetics of choice are cyclizine or levomepromazine, and a non-oral route is required to ensure its activity. Absorption of bacterial toxins from a stagnant or ischaemic area of obstructed bowel can also trigger nausea via the chemoreceptor trigger zone: this situation would require the use of a CTZ antiemetic in addition to cyclizine, and haloperidol is the drug of choice, again by a non-oral route. Dehydration can complicate proximal obstruction, as intestinal secretions are vomited along with any ingested fluids.
Patients should aim to take 200–400 ml daily (that is, 300–600 kcal), accepting that this will suppress some normal food intake but provide a net gain of 200–400 kcal a day. When a patient complains of severe anorexia or early satiety it may be necessary to provide an appetite stimulant. Moderate alcohol consumption before and during a meal may help. Prednisolone (5 mg three times a day) or dexamethasone (4 mg a day) can improve appetite and mood but are not generally suitable for long term use (that is, more than six to eight weeks) due to loss of efficacy and side effects including muscle wasting.
Greater understanding of the complex pathophysiology of both cachexia and anorexia will hopefully provide new targets for drugs, which, in combination with better trial design, should lead to future progress. 24 Barber MD. The pathophysiology and treatment of cancer cachexia. Nutr Clin Pract 2002;17:203–9. ● Gordon JN, Green SR, Goggin PM. Cancer cachexia. Q J Med 2005;98:779–88. ● MacDonald N, Easson AM, Mazurak VC, Dunn GP, Baracos VE. Understanding and managing cancer cachexia. J Am Coll Surg 2003;197:143–61.
ABC of Palliative Care by Marie Fallon, Geoffrey Hanks