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Education in Palliative and End-of-life Care - Oncology

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

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Education in Palliative and End-of-life Care - Oncology

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  1. The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC-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 3f Symptoms – Constipation

  3. Constipation . . . • Straining • Hard stool • Sensation of • Incomplete evacuation • Anorectal obstruction • Fewer than 3 BM / week • 12 weeks duration > 2 symptoms

  4. . . . Constipation Epidemiology • Impact: abdominal discomfort / pain, nausea and vomiting • Prevalence: up to 90 % among cancer patients treated with opioids • Prognosis: can limit prognosis if untreated • Management always possible

  5. Key points • Pathophysiology • Assessment • Management

  6. Medications Opioids Calcium-channel blockers Anticholinergic Decreased motility Ileus Mechanical obstruction Metabolic abnormalities Spinal cord compression Dehydration Autonomic dysfunction Malignancy Pathophysiology

  7. Assessment • Specifically ask about bowel function • Establish what is normal for patient

  8. General measures Regular toileting Gastrocolic reflex Activity Specific measures Softeners Osmotics Stimulants Lubricants Large volume enemas Management

  9. Stool softeners(detergent laxatives) • Sodium docusate • Calcium docusate • Phospho-soda enema PRN

  10. Stimulant laxatives • Prune juice • Senna • Casanthranol • Bisacodyl

  11. Osmotic laxatives • Lactulose or sorbitol • Milk of magnesia (other Mg salts) • Magnesium citrate • Polyethylene glycol Lederle FA, et al. Am J Med, 1990. Attar A, et al. Gut, 1999.

  12. Lubricants / enemas • Glycerin suppositories • Phosphate enema • Oil retention enema • Tap water, 500 – 1,000 ml

  13. Constipation fromopioids . . . • Occurs with all opioids • Pharmacological tolerance develops slowly, or not at all • Dietary interventions alone usually not sufficient • Avoid bulk-forming agents in debilitated patients Bagnol D, et al. Neuroscience, 1997.

  14. . . . Constipation fromopioids • Combination stimulant / softeners are useful first-line medications • Casanthranol + docusate sodium • Senna + docusate sodium • Prokinetic agents • Opioid antagonists Sykes NP. Palliat Med, 2000.

  15. Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience

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