Palace of Care – Saying No – Part 3

Photo by Christina Deravedisian on Unsplash

He was admitted because of uncontrolled nausea and vomiting. We thought it might be a malignant bowel obstruction but his bowel sounds were normal. He would vomit at least three times a day. Strangely the vomiting didn’t seem to bother him, in fact at times he and his wife seemed happy after he vomited. We weren’t sure of what was causing his nausea and vomiting, his blood tests showed evidence of dehydration, but there was nothing obviously reversible going on to explain his symptoms. He looked unwell and after a few days on our ward he appeared more gaunt. Our attempts at controlling his symptoms were not working, we hadn’t solved the mystery yet, until we noticed the half-filled blue glass bottle on his table. “Keep out of direct sunlight.”

Continue reading

Study shows why cancer patients are asking for medicinal cannabis

I can tell you, it’s true! Many cancer patients are asking their clinicians for medicinal cannabis – but worryingly,  around one in four patients believing it will help in control or cure the cancer, a Victorian study has found.

This study was carried out by a team at the Victorian Comprehensive Cancer Centre and Parkville Integrated Palliative Care Service, lead by Dr Stacey Panozzo, investigated the characteristics and medicinal cannabis requests of 1700 patients with breast, colorectal, melanoma and oesophageal cancer patients attending the three centres over a six month period in 2018-2019.

The study was also featured in this Limbic Oncology article.

Continue reading

Putting the CAR-T before the horse?

Dr Benjamin Thomas’s excellent thread about economic justice for palliative care patients in the context of the announcement of a likely announcement regarding the Government funding around 200-250 patients for $500,000 each to receive CAR-T treatment.

He calculates what we could do for palliative care patients with the same money.

Worth a read! Thanks Ben @andiyarus

https://threadreaderapp.com/thread/1222006604289101824.html

 

 

Announcement re CAR-T funding

 

deprescribing at end of life

My pen poised over the drug chart, I hesitate.

Mr Jones* is a 58-year-old patient that my consultation palliative care team is seeing while he’s in hospital with complications of chemotherapy for advanced lung cancer. I am reviewing his discharge medications before he returns home to the care of the community palliative care team.

He is a very optimistic person, not keen to discuss the possibility of his cancer not getting better. An overweight hypertensive smoker, he’s on a full hand of antihypertensives, anti cholesterol medications, vitamin D supplements, a multi-vitamin, and antiplatelet therapy.

His prognosis is likely less than a year in my mind. Does he need all these medications?

A retrospective cohort study by Todd et al examined this question in groups of people with advanced lung cancer in the United States and the UK. The patients had died and been admitted to hospital then discharged at least once in their last 6 months of life.  Continue reading