Comment: Keeping the balance
Dame Cicely Saunders
pp 4-4
The request of the young Jew from Warsaw, David Tasma – dying of cancer in a busy London hospital – of, ‘I only want what is in your mind and in your heart’ led to an answer that ultimately helped him to return quietly to the faith of his fathers. His words call for a re-emphasis on both science and spirituality, highlighting the need to keep a balance between these complementary claims on our skills and on our humanity.
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Tumour-induced hypercalcaemia
Anthony Howell
pp 5-7
Tumour-induced hypercalcaemia (TIH) is one of the most common metabolic disorders associated with cancer. This potentially life-threatening syndrome requires urgent treatment, since it may progress rapidly, leading to complications or even death. It is generally accepted that TIH occurs in 10–20% of cancer patients at some point during their disease. Some reports cite a higher incidence – up to 30% of cases according to one study.
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Insomnia and sleep disturbances
Piero Sanna and Eduardo Bruera
pp 8-12
Sleep is an essential factor for wellbeing and quality of life in both healthy and ill individuals. Disturbances in quantity and quality of sleep can result in physical and psychological distress and can also interact and worsen pre-existent medical co-morbidities. Cardiopulmonary, cerebral-vascular, renal, tumoural and psychiatric diseases are quite often associated with disturbances of the normal sleep activity. Fortunately, in the last decade, increasing research in this field has resulted in improved knowledge about the mechanisms of sleep.
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Case study masterclass 1: Carcinoma of the gastric fundus
Carol Davis and Tim Harrison
pp 14-15
You are asked to advise on the care of a 66-year-old widow who has been an inpatient on the oncology ward for three weeks. Five months ago, inoperable carcinoma of the gastric fundus was diagnosed on endoscopy. Palliative chemotherapy was started with a regimen based on 5-fluorouracil administered by continuous infusion.
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Malignant brain tumours and palliative care
Susan Brajtman, Daniel Azoulay, Ruth Gassner and Malka Yeheskel
pp 16-19
Within the palliative care setting, clinical staff often find their resources being challenged in order to meet the multiple, evolving and often unpredictable needs of patients with brain tumours and the needs of their families. Patients with brain tumours may suffer from a complex spectrum of multiple physical symptoms that are often accompanied by emotional, cognitive and sensory changes. Death may not be imminent for these patients, and as a result the changes in their cognitive status, combined with the uncertainty of their death, often create a climate that can make even the most seemingly routine decisions a matter of intense debate over their inherent ethical implications.
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A multidisciplinary approach to terminal care
Kate Jones and Morag McIntye
pp 21-24
The traditional system of documentation in healthcare has been for each discipline involved with the care of patients to keep its own records. Thus, cross-fertilisation of information is rarely sought or used effectively. These recording methods may hinder a true evaluation of interventions, the effectiveness of a service, and the collaborative involvement of a multidisciplinary care team, particularly in the palliative care setting.
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Suffering and the end of life
Marc Magnet
pp 25-28
'It takes you all your life to learn how to live, and it takes you all your life to learn how to die.' The suffering observed in the terminal stage of cancer is that of a person whose life is drawing to a close. To speak of ‘the sick person’ is a reminder of the fact that this person is experiencing a changed existence.
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The use of an occupational therapy programme within a palliative care setting
Charlie Ewer-Smith and Sarah Patterson
pp 30-33
'From the moment of diagnosis and throughout the survival period, the individual with cancer faces many potential stressors. Recognising these stressors and learning to deal with their effects on lifestyle and daily living may improve quality of life and the range of coping mechanisms.’ Occupational therapists (OTs) are able to assess the impact of anxiety and stress on an individual’s function and employ relaxation techniques as one method of reducing anxiety levels and positively impacting function.
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Teaching through artwork in terminal care
Brandon Williams
pp 34-36
Palliative care, by its very nature, is concerned with sensitive and emotional issues which need to be addressed in any educational programme involving health professionals working in this area. Issues such as the ethics of truth-telling, mortality, spirituality, identification and vicarious trauma generate a great deal of catharsis, particularly in a group education setting. When a group of individuals explore such areas, a range of feelings emerge depending on individual perspectives – each one being different due to personal subjectivity but correct in its own right. Educators must consider a range of activities to maximise learning from these perspectives while maintaining a ‘safety net’ to avoid exploitation of vulnerability during personal disclosure in the classroom setting.
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