Hematology and Oncology Book

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Cancer SymptomAka: Cancer Emergencies, Oncologic Emergencies

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  1. Symptom Prevalence
    1. Asthenia (Fatigue): 90%
    2. Anorexia: 85%
    3. Cancer Pain: 76%
    4. Nausea: 68%
    5. Constipation: 65%
    6. Sedation or confusion: 60%
    7. Dyspnea: 12%
  2. Management: Cancer Emergencies
    1. Metabolic cancer complications
      1. Tumor Lysis Syndrome
      2. Syndrome of Inappropriate Antidiuretic Hormone: SIADH
      3. Malignant Hypercalcemia
    2. Infectious and hematologic cancer complications
      1. Neutropenic Fever
      2. Hyperviscosity Syndrome
    3. Vascular Complications
      1. Epidural Spinal Cord Compression
      2. Malignant Cardiac Tamponade
      3. Superior Vena Cava Syndrome
    4. Chemotherapy Complications
      1. See gastrointestinal symptoms below
      2. Chemotherapy Extravasation
    5. References
      1. Higdon (2006) Am Fam Physician 74:1873
  3. Management: Symptoms
    1. Dental
      1. See Mouth Care in Cancer
    2. Dermatology
      1. See Fungating Growths
    3. Pain
      1. See Cancer Pain
    4. Dehydration in Cancer Patients
      1. See Cachexia in Cancer
      2. See Hypodermoclysis
      3. Only treat if it improves quality of life
      4. Risk Intravenous fluids: Iatrogenic pulmonary edema
    5. Hypercalcemia
      1. Most common serious palliative care metabolic effect
      2. Always keep in mind and test for it!
      3. Fluids effectively treat Hypercalcemia in most cases
    6. Gastrointestinal
      1. See Nausea in Cancer
      2. See Diarrhea in Cancer
      3. See Constipation in Cancer
      4. See Cachexia in Cancer
    7. Pulmonary
      1. See Dyspnea in Cancer
    8. Neurologic and Psychiatric
      1. See Mood Disorders in Cancer
      2. See Delirium in Cancer
    9. Rheumatology
      1. See Fatigue in Cancer
    10. Cerebral Edema
      1. Treat with Dexamethasone (and concurrent H2 Blocker)
    11. Fluid Third Spacing
      1. Malignant Ascites
      2. See Pleural Effusion in Cancer
  4. Special circumstances
    1. Terminal patients who choose not to eat or drink
      1. Some patients will choose to hasten their own death
      2. Competent patients may refuse to take nourishment
      3. Study looked at suffering, pain and duration to death
        1. Patients died within 2 weeks of stopping intake
        2. Low level of pain and suffering
        3. Ganzini (2003) N Engl J Med 349:359
  5. References
    1. Storey (1996) Primer of Palliative Care, AAHPM
    2. Ross (2001) Am Fam Physician 64(6):1019
    3. Ross (2001) Am Fam Physician 64(5):807
  6. Resources
    1. End of Life Physicians Education Resource
      1. http://www.eperc.mcw.edu

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