Supportive Care II

Question 1

How do we assess pain within Cancer?

Answer 1

• O: Onset
• P: Provokes
• Q: Quality
• R: Radiate
• S: Severe
• T: Time
• U: Understanding?

Question 2

What are a few of the principles around pain management in Cancer?

Answer 2

• Cause?
• Around the clock WITH prn
• Lowest dose possible

Question 3

What is the tiered system for the treatment of Pain in Cancer?

Answer 3

• Pain: non-opioid +/- adjuvant
• More Pain: Opioid +/- non-opioid +/- adjuvant
• MORE PAIN: Opioid +/- non-opioid +/- adjuvant

Question 4

What are some of the opioids that are used in the treatment of pain in Cancer?

Answer 4

• Morphine, Hydromorphone, Oxycodone, Fentanyl, Methadone

Question 5

What are some important things about Morphine in Cancer?

Answer 5

• Metabolized in the liver & excreted renally
• Liver dysfunction

Question 6

What is important to know about Hydromorphone in Cancer?

Answer 6

• Metabolized in the liver & excreted renally
• MORE potent than Morphine

Question 7

What is important to know about Oxycodone in Cancer?

Answer 7

• Metabolized by 2D6
• Renal Failure can over sedate and CNS toxic
• Liver dysfunction
• NO PCA [no IV]

Question 8

What is important about Fentanyl in Cancer?

Answer 8

• MOST POTENT PAIN MED
• Metabolized in liver
• SAFE in renal & liver dysfunction
• Patch, IV, buccal, nasal spray, lozenges

Question 9

What is the dangerous thing about Fentanyl?

Answer 9

• Respiratory Depression

Question 10

What is important to know about Methadone in Cancer?

Answer 10

• NOT GO TO
• Very unpredictable [t1/2 = 8 to 59h]
• QTc Prologation

Question 11

What are some of the common toxicities for opioids in Cancer?

Answer 11

• CONSTIPATION: [ADD bowel regimen - NO tolerance]
• Sedation
• N/V
• Pruritis: Mainly with morphine
• Hallucination
• RESPIRATORY DEPRESSION: [give narcan]

Question 12

What is a Patient Controlled Analgesia?

Answer 12

• PCA: patient demand +/- infusion of opioid [when they want it]
• NOT family controlled

Question 13

If a patient has Sleep Apnea, should a PCA be used?

Answer 13

• NO
• first 24 hours after surgery is the highest for sedation & respiratory depression

Question 14

How do you change a PSA?

Answer 14

• Calculate 24hr dose
• Convert
• Reduce by 25%
• Divide into doses
• ADD PRN

Question 15

In what type of Cancer is a Celiac Plexus Block used in?

Answer 15

• Pancreatic Cancer - Blocks the nevere that supply to the organs in the abdomen

Question 16

What is important to know to know about VTE and Cancer?

Answer 16

• x9 more risk of VTE with Cancer

Question 17

What are some of the monotherapy options for VTE in Cancer?

Answer 17

• DOACs [WITHOUT GI lesions]
• LMWH [WITH GI lesions]
• 3 moths duration

Question 18

What are some fo the Combo therapies for VTE in Cancer?

Answer 18

• LMWH –> Edoxaban
• LMWH/UFH/Fondaparinux –> Warfarin
• 3 month duration

Question 19

What was the result from Comparion of Low-Molecular-Weight Heparin vs Oral Anticoagulation Therapy [CLOT] in Cancer?

Answer 19

• LMWH > Warfarin??
• Results: Dalteparin was better than Warfarin in decreasing VTE

Question 20

When screening for breast cancer, what is important to know?

Answer 20

• Mammogram @ 45-55 yearly then >55 every two years

Question 21

What are some preventions that you can do for Breast Cancer?

Answer 21

• High Risk = surgery [BRAC 1 = Ovarian & Breast]
• Tamoxifen & Raloxifene are approved for prevention [can use both]

Question 22

What is important to know about Tamoxifen?

Answer 22

• Agonist & Antagonist = Increase Bone and Increase Endometrial cancer

Question 23

When screening for Prostate Cancer, what is important to know?

Answer 23

• DRE [how does it feel?] & PSA [normal 0-4]
• Men > 50 y –> PSA [>2.5 yearly; <2.5 2 years] +/- DRE
• HIGH RISK: Screen at 45 yo

Question 24

What are some preventions for Prostate Cancer?

Answer 24

• Finasteride [5a-reductase] BUT only 25% had a decreased risk [those that got prostate cancer had a higher gleason score]

Question 25

When screening for Colon Cancer, what is important to know?

Answer 25

- Test: Primary Detect Cancer [FIT, FOBT] or Detect Cancer [Colonoscopy]

Question 26

What are the Primary Detect test of Colon Cancer?

Answer 26

- FIT: detects hemoglobin - FOBT: blood test?

Question 27

What is Primary Detect Cancer and Advanced Lesions of Colon Cancer? | how do we detect?

Answer 27

- Colonoscopy: looks at the whole bowel and can remove anything precanerous

Question 28

When should patient be screened for Colon Cancer?

Answer 28

- **>45 years old** - Colonoscopy **every 10 years**

Question 29

What are some of the preventions for Colon Cancer?

Answer 29

- COX inhibitors: Celecoxib - NSAIDS - Remove colon

Question 30

When screening for Lung Cancer, what is important to know?

Answer 30

- No real effective way

Question 31

When screening for Ovarian Cancer, what is important to know?

Answer 31

- No effective screening tool - LOW RISK: annual physical - HIGH RISK: Pelic exam, transvaginal ultrasound [looking for hereditary or BRAC]

Question 32

What are some of the ways that we can prevent Ovarian Cancer?

Answer 32

- Oral contrceptives - your not ovulating as much - Removing the Ovaries - if BRAC1 & 2

Question 33

When screening for Melanoma, what is important to know?

Answer 33

- Exam the WHOLE body - History - clinical examination

Question 34

What are some ways that we can prevent melanoma?

Answer 34

- SUNSCREEN of SPF > 15 - Avoid tanning beds - Avoid direct sunlight form 10am to 4pm