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

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

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  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 3l: Symptoms – Insomnia

  3. Insomnia . . . • Definition: inadequate or poor-quality sleep • Difficulty falling asleep • Difficulty maintaining sleep • Early morning awakening • Nonrefreshing sleep

  4. . . . Insomnia Epidemiology: • Impact: tiredness or fatigue, anergia, poor concentration, irritability • Up to 63% of cancer patients • Restful sleep can often be restored

  5. Key points • Pathophysiology • Assessment • Management

  6. Pathophysiology • Multiple possible causes • Prior sleep disorder • Uncontrolled symptoms • Pain • Pruritis • Depression • Anxiety • Medications

  7. Assessment • Determine course and pattern • Lifelong pattern or recent? • Difficulty falling asleep? • Early awakening? • Spouse observations? • Other unrelieved symptoms?

  8. Management . . . • Regular sleep schedule, avoid staying in bed • Avoid caffeine, assess alcohol intake • Cognitive / physical stimulation • Avoid overstimulation • Control pain during the night • Relaxation, imagery

  9. . . . Management • Antihistamines • Benzodiazepines • Neuroleptics • Sedating antidepressant (trazodone) • Careful titration • Attention to adverse effects

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

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