Once a cancer patient is terminal, the aim is no longer to achieve a cure but to manage any distressing physical or psychological symptoms. Palliative care focuses on the comfort and care of those nearing death. The palliative care team chooses medications for terminal cancer patients to achieve the new goals of care and comfort.
Shortness of Breath
The sensation of shortness of breath, or air hunger, occurs in 20 to 80 percent of palliative care cancer patients according to StopPain.org. Causes include advanced lung disease such as cancer or emphysema, low numbers of red blood cells, fluid in the lungs and anxiety. In addition to oxygen, morphine helps by easing the urge to breathe, bronchodilators help if the airway is spasming and sedatives like benzodiazepine manage anxiety. In 2008, the article "Interventions for Alleviating Cancer-Related Dyspnea" published in the "Journal of Clinical Oncology" found that morphine was the most effective overall at relieving shortness of breath.
Pain
Stoppain.org notes that the treatment of pain is important since pain causes depression, loss of hope, loss of sleep and withdrawal from social interactions. Care Search reports that evidence points to treating cancer pain with nonsteroidal anti-inflammatory drugs like ibuprofen, morphine and radiation therapy. Bisphosphonates are effective for tumors in the bone and tramadol is effective for nerve pain. To maintain pain relief the World Health Organization published a three step "Pain Relief Ladder" which is utilized by palliative care teams.
Anxiety and Depression
Symptoms of anxiety include fear, apprehension, restlessness, insomnia and muscle tension. Depression symptoms include a loss of hope, inability to enjoy anything, suicidal thoughts and withdrawal from friends and family. Often the two conditions occur together. Both anxiety and depression occur because of a fear of death, poorly controlled pain, concern about being a burden or medical conditions like electrolyte imbalance or brain tumors. Care Search notes medications that are helpful for anxiety include morphine, antidepressants and tranquilizers such as benzodiazepine. Counseling is a helpful addition to medication.
Gastrointestinal
The symptoms of nausea, vomiting and loss of appetite occur for many reasons. The cancer itself, prior surgery for the cancer, prior chemotherapy and medications like antibiotics or painkillers are all possibilities. Care Search reports the use of anti-nausea medications such as metoclopramide and appetite stimulants such as corticosteroids and progestogens-although according to Care Search the way they improve appetite is not well understood.
Delirium
Patients with advanced cancer commonly experience delirium. Symptoms include mood changes, hallucinations, confusion, memory loss and agitation. Stoppain.org lists the anti-psychotics haloperidol, methotrimeprazine, thioridazine and chlorpromazine as the drugs used in managing delirium.
