By Chen Yingle (Clinical Assistant Professor, Department of Clinical Oncology)
In the face of advanced cancer, although modern medicine has advanced, there are many new drugs and treatment options, which are more effective and have fewer side effects than before, but they still cannot be completely cured.
Patients can choose anticancer treatment, palliative treatment, or even both.
But no matter which treatment plan you choose, the most important thing is to make good use of the limited time and cherish the opportunity to get together with your family.
(Hong Kong News) Mr. Zeng is 75 years old this year. Unfortunately, he was diagnosed with lung cancer, which has metastasized to the liver, bone and lymphoid tissue. The tumor has eroded the spine and caused him back pain.
Because no genetic mutations were found in the tumor tissue, doctors suggested chemotherapy as the first-line treatment to control the disease.
He and his son came to the clinic and asked some questions about chemotherapy and palliative care, which I believe are also the questions of many patients.
Prolonged stable period to prevent complications
Question 1. The patient is very old, is it suitable for chemotherapy?
Whether the elderly are suitable for anti-cancer treatment does not depend on age, but more importantly, the patient’s physical condition, past health records, current organ functions (such as hemoglobin, liver and kidney function, etc.), self-care ability, family support and patient wishes .
Progression of advanced cancer is difficult to predict
Question 2. If you do not receive chemotherapy, is it equal to “waiting time”?
If a patient does not receive chemotherapy due to personal wishes or physical condition, it does not mean “waiting for time”, nor does it mean a negative attitude.
On the contrary, it is a positive attitude to understand that life is limited, to cherish and plan time and energy well, to accomplish what you want to do. These things can be in different categories, small things such as reading a book or a movie, having dinner with friends, going to a short trip, or household matters such as estate distribution, care arrangements, etc.
The progression of advanced cancer is unpredictable, and patients usually remain stable for a period of time after diagnosis, then deteriorate, begin to lose weight and become weak, and eventually die. This stable period is different for each patient, some are longer and some are shorter, and the disease may recur or new symptoms may appear. We hope to extend this stable period and reduce the occurrence of complications.
Reduce unnecessary invasive treatment
Q3. Can palliative care be used after chemotherapy?
no. Palliative treatment is not giving up treatment, it can be done simultaneously with other treatments.
Palliative care aims to provide holistic care and support services in all aspects of body, mind, society and spirit for terminally ill patients and their families. Prevent and alleviate suffering through early identification, proper assessment, and treatment of pain and other physical, psychological or spiritual problems, and help patients live peacefully and productively in the final stage of life, and go through life journey peacefully, while providing emotional support for family members and tutoring.
Palliative care affirms the preciousness of life, while treating death as an inevitable phase of life, neither hastening nor postponing death. The palliative care team includes doctors, nurses, social workers, clinical psychologists, physical therapists, occupational therapists, religious figures, etc.
In the past, patients often started to receive palliative care after the anticancer treatment was exhausted, which led to the following problems:
◆Doctors lack understanding of patients’ symptoms and pain when doing active anticancer treatment
◆Patients feel sudden when they are referred to palliative care and feel abandoned by healthcare workers
◆Patients and family members do not have enough time to prepare psychologically
It is now medically recommended that palliative care should be integrated into cancer treatment as early as possible. The benefits include:
◆Making patients and families more satisfied with care and treatment
◆Maintain and improve the quality of life of patients
◆Reduce depression and anxiety in patients during exacerbations
◆Reduce unnecessary invasive treatment when the patient is near the end of life
Intervention according to patient needs
Question 4. Will the patient feel very uncomfortable in the final stage? Will it hurt?
Don’t worry, the treatment team will always follow up the patient’s condition and use relieving drugs appropriately.
For example, for pain, there are different painkillers to help patients relieve pain,
In addition to more common pain relievers such as paracetamol,
Higher grade weak opioid pain relievers are also available
(e.g. tramadol, codeine);
or strong opioid pain relievers
(e.g. morphine, oxycodone, fentanyl, etc.).
In addition, doctors will also use interventional therapy according to the patient’s needs, such as local nerve anesthesia, radiation therapy to relieve pain; another example is asthma, there are also different ways to relieve it. In addition to drugs, non-drug treatments can be considered. For example, if it is as simple as using a portable electric fan, fix the fan at a distance of about 20 cm from the face, let the cool wind blow to the cheekbones of the face, and the patient will feel that the symptoms are relieved.
Most patients will go through the last period of life peacefully. We understand that patients are afraid of disease and death, and we will accompany patients and their families to face it together.
Community Palliative Care App
supporttake care at homeCancer
“Home Support” community-based palliative care app is a project of the Department of Clinical Oncology, The University of Hong Kong.
With the meaning of “strengthening” family support, the app hopes to support cancer patients and their families to take care of them at home, add available resources for them, and face cancer with a positive attitude; for example, “know more” in the app There is information on cancer information, palliative care and palliative care available so that patients and carers can equip themselves with the knowledge and skills to care at home.
Text Chen Qiurui
Pay attention to smooth breathing during rehabilitation exercises
Question 1. What should heart disease patients pay attention to when doing rehabilitation exercises?
Answer 1.When patients are doing rehabilitation exercises, they must pay attention to whether their breathing is smooth. Physiotherapists generally use the Talk Test to identify it. This speaking test is mainly a method of judging the intensity of exercise based on the comfort level of speaking during human exercise.
The physical therapist will ask the patient questions to test whether the patient is breathing well and is fit to continue to exercise while exercising. According to the test, a score of 0 to 10 is used as an indicator, 3 is moderate, 4 is somewhat difficult, and 5 is difficult. A score of 3 to 5 can be defined as “enough breathing to continue a smooth conversation.” However, if your breathing is not smooth during exercise, you can slow down or pause, rest for a period of time to adjust your breathing before continuing. If the same problem reappears after rest and continues to exercise, and this situation persists; or if you feel dizzy, weak, chest tightness, irregular heartbeat, then you must stop completely at this time and consult a doctor.