The EPEC-O Project Education in Palliative and End-of-life Care - Oncology

1. TM The EPEC-O Project Education in Palliative and End-of-life Care - Oncology The EPECTM-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

2. EPEC– Oncology Education in Palliative and End-of-life Care – Oncology Module 3A Symptoms: General Introduction

3. Objectives . . . • Discuss general assessment and management guidelines. • Describe the possible causes and underlying pathophysiology. • Conduct a careful assessment. • Initiate management including rapid and breakthrough dosing.

4. . . . Objectives continued • Describe principles of multi-symptom management • Understand principle of double effect

5. Video

6. Introduction • Most cancer patients have fatigue, pain, other symptoms. • Poor symptom control undermines completion of antineoplastic treatment. • Symptom control is necessary for patient goals.

7. Symptom management • Best medicine - treat cause & experience • Pharmacology • Surgery • Radiation • Chemotherapy • Clinical trials • Other

8. Assessment and plan • Comprehensive assessment • Conceptualize likely causes • Discuss treatment options • Negotiate goals of care, treatment priorities

9. Information gathering • Common symptoms • Collect chart information: • Onset, location, quality, timing, severity, effect of medication, adverse effects • Use scales to assess, chart severity

10. Manage quickly • Treat the cause of the symptom • Manage the experience • Continuous dosing • Breakthrough/intermittent dosing

11. Coordinate care • Educate the patient, family, caregivers • Include the interdisciplinary team • Involve palliative care consultants • Reassess often

12. Intended vs. unintended consequences • Primary intent dictates ethical medical practice • Double effect • Definition • Minimal application in palliative care

13. Rationalize management • Multiple symptoms • Optimize noninvasive, non-pharmacologic approaches • Avoid polypharmacy • Use 1 agent for 2 symptoms if possible • Consider adverse effects • Preempt interactions • Use renal and hepatic dosing as needed • Terminal sedation • Involve palliative care specialists

14. Summary • Principles of symptom management • Understand the pathophysiology • Manage quickly; continuous & breakthrough dosing • Rationalize multisymptom management • Coordination of care • Patient, family education • Interdisciplinary team • Intended versus unintended effects • Terminal sedation requires consultation