1 / 15

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.

irving
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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 3f: Symptoms -Constipation

  3. Constipation . . . • Straining • Hard stool • Sensation of • Incomplete evacuation • Anorectal obstruction • Fewer than 3 bowel movements per week • 12 weeks duration with 2 or more 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 • Pharmacologic 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.

More Related