Dyspnea in terminally ill cancer patients

To determine the epidemiology of dyspnea in terminal cancer patients, we examined data from the National Hospice Study, which followed up patients during their last six weeks of life. The incidence of dyspnea in these patients was 70.2 percent, with prevalence rates generally exceeding 50 percent at any of three measurements. In addition to lung or pleural involvement by the tumor, the presence of underlying lung disease or cardiac and low performance on the Karnofsky scale were significantly associated with dyspnea. Lung, colorectal, and breast carcinomas were the most common tumor sites in our dyspneic patients and accounted for almost 60 percent of cancer diagnoses in these patients. In 23.9 percent of dyspneic terminal cancer patients, neither lung or pleural involvement nor underlying lung or heart disease could be identified as risk factors.     

Management of bleeding in the terminally ill patient

Clinically significant bleeding occurs in approximately 6%-10% of patients in the palliative-care setting. Bleeding can range from persistent and small in quantity (but enough to interfere with a patient's quality of life), to catastrophic bleeding that ultimately leads to the rapid demise of the patient. Uncontrolled bleeding can be very distressing for staff, patients and families. Advanced planning is necessary in all bleeding circumstances. This session will review the types of cancer associated with bleeding, as well as management options for these situations. Emphasis will be placed on aspects of communication with families.     

Management of bleeding in the terminally ill patient

Clinically significant bleeding occurs in approximately 6%-10% of patients in the palliative-care setting. Bleeding can range from persistent and small in quantity (but enough to interfere with a patient's quality of life), to catastrophic bleeding that ultimately leads to the rapid demise of the patient. Uncontrolled bleeding can be very distressing for staff, patients and families. Advanced planning is necessary in all bleeding circumstances. This session will review the types of cancer associated with bleeding, as well as management options for these situations. Emphasis will be placed on aspects of communication with families.     

Clinical management of the terminally ill.

Physicians who provide primary care for the elderly are spending more time caring for terminally ill patients. Although curing these patients' illnesses is impossible, it is often possible to improve their quality of life and give them more control over their illness. Communication with the patient and family members, advance directives, and planning for death are important. Symptoms such as pain, dyspnea, and nausea can usually be controlled. Other health care professionals and hospice care when appropriate can also be helpful.     

Symptom profile in terminally ill AIDS patients

A study protocol to record prospectively, frequency and intensity of symptoms in terminally ill AIDS patients was developed. Other information included mode of transmission, active intravenous drug use, regular visits of family/friends to the ward, the use of symptom-control drugs, and death without family or partner. The study population was selected from patients admitted to the wards or followed in the Clinic or Day Center of the Department of Infectious Diseases of the Catholic University, Rome. Inclusion criteria were diagnosis of AIDS prior to 12 months and advanced stage AIDS (defined with standardized criteria). To standardize the analysis of data, the terminal phase was considered to start 3 months before death (T1). From January 1, 1993 to December 12, 1993, 266 patients (208 males, 58 females) were enrolled. By June 30, 1995 168 patients had died and were considered for analysis. The most frequent symptoms at T1 were anorexia (63.1%), fatigue (60.1%), pain (60.1%), fever (47.6%), and cough (37.5%). At the end week (T6) the most frequent symptoms were fever (81.5%), fatigue (70.2%), dyspnea (68.1%), and pain (58.9%). In two-thirds of the patients, symptom-control drugs were used, most frequently nonopioid analgesics (39.9% at T1 and 56.5% at T6) and antipyretics (38.7% at T1 and 53.6% at T6). Opioid analgesics were used in 19% of patients at T1 and in 28.6% at T6. Almost one-third of the patients (29.2%) died alone without having family, their partner, or a friend near. Considering the high frequency of treatable symptoms in terminally ill AIDS patients, the use of palliative therapy should be emphasized. Flexibility and patient-directed care should be used in deciding care plans to avoid overhospitalization and promote alternative care.     

Urinary incontinence and the terminally ill older person

The principles of managing urinary incontinence in an older patient who has a terminal illness should be based on the general principles of overall care for terminally ill older persons. First, health care professionals need to understand "where" the person is in the dying process. Second, they must be able to predict, with as much accuracy as possible, the consequences of any action or inaction(that is, a decision made not to do an intervention that typically is done). Third, they must understand how the patient's symptom is uncomfortable and bothersome from the patient's standpoint. All three steps need to take into account the family's perception of the patient's discomfort, and, whenever possible, the family should be involved in the decision making.     

The physician's role with the terminally ill patient

The physician encounters many issues and problems when working with the terminally ill. It is important to remember that the most important aspect of care for the dying is to maintain open and honest communication among the doctor, the patient, and the family. In brief, the physician should play a major role in helping the dying patient. Open communication and support must be continually provided by the physician, both to the dying patient and to the family. All it takes, basically, is common sense and human compassion. No matter how often the physician treats dying patients, he or she should never be casual or matter-of-fact about death. Death should always command respect and awe, but it need never terrorize us or cause us to turn away from providing help to the dying patient. Those who care for the terminally ill may find, to their surprise, that great satisfaction can be derived from this work. One becomes enriched by observing the courage of many dying patients. Therein lies the challenge and the reward.     

Nutritional support in terminally ill situation. Ethical dilemmas

Malnutrition is a common complication in terminally ill situation. Artificial nutritional support in these patients create a host of ethical conflicts with difficult solutions. In this paper we give simple suggestions that might the help care provider in making a viable clinical decision. However, each case should be treated in an individualized manner taking into consideration the ratio between risks and benefits of this treatment. The patient's wishes should have the highest priority.