Updates in palliative care – recent advancements in the pharmacological management of symptoms

Abstract

Symptom management is an important part of both palliative care and end-of-life care. This article will examine the recent research evidence about drugs commonly used for symptom management in adult patients receiving palliative care. In particular, the management of symptoms where recent palliative care-based evidence has changed recommended practice will be reviewed. This includes: breathlessness, delirium, nausea and vomiting in bowel obstruction, opioidinduced constipation and upper respiratory tract secretions. For each symptom, a review of recent pharmacological evidence has been undertaken, with emphasis on potential important changes to physicians' practice.

Anticholinergic Burden in Hospice Patients With Dementia

“…These medications are typically prescribed to manage terminal secretions. 22 Excessive respiratory tract secretions are a common symptom that affects 23% to 92% of dying patients. 23 Although there is no evidence that these secretions are associated with respiratory distress in the patient, they are often treated in order to ease caregiver distress.…”

Response to “Hyoscine Butylbromide for the Management of Death Rattle: Sooner Rather Than Later”

“…Previous studies have administered anticholinergic drugs to treat already formed noisy RTS rather than preventing their formation, but anticholinergic drugs are unable to remove secretions already formed. 2,3 This exploratory study presents promising effects; however, the data should be interpreted in the context of its methodological limitations. The natural history of RTS is poorly described, so attribution of outcomes is difficult in an unblinded trial.…”

“…Importantly, harms were not reported, but it is vital to know about toxicity when proposing a prophylactic treatment (potentially for the benefit of family and staff rather than the patient) [4][5][6] where a significant number of people would never develop noisy RTS (40% in comparator arm of present study) but nevertheless have now been exposed to a drug with a significant harm profile (including dry mouth, constipation, and urinary retention). 2,3 In particular, anticholinergics are known to contribute to deliriumdof concern in this high-risk population. 7 To make clinical judgments, we must be able to evaluate the net-benefit (harms-benefit balance) of exposing patients to a medication they might not need but might cause clinically important harms.…”

Delivering a dignified death in a challenged national health system

“…This is a challenging subject encompassing moral and ethical, legal, 1 religious, 2 scientific medical 3 and managerial domains that spans primary, social and…”