Devita, Hellman, and Rosenberg's Cancer

LWBK1006-45 LWW-Govindan-Review December 13, 2011 15:32

568 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

their current treatment program to benefit from additional services pro-

vided by palliative care specialists. Several studies in the United States,

Canada, and England demonstrated that hospital-based palliative care

programs are generally cost-saving for the hospitals. For example, stud-

ies done in palliative care units demonstrated significantly decreased daily

charges and decreased total costs for patients who died in the unit,

compared with age and diagnosis-matched patients who died outside

the unit.

Answer 45.7. The answer is B.

Delirium is present in up to 80% of dying patients. Delirious patients may

appear agitated or hypoactive, or may alternate between these states. Fre-

quent symptoms of delirium include insomnia, restlessness or agitation

(which can mimic uncontrolled pain), irritability, anxiety, and hallucina-

tions.

Answer 45.8. The answer is B.

Oral dose of 20-mg methadone is equivalent to 200 mg of codeine, 7.5 mg

of hydromorphone, 100 mg of propoxyphene, and 30 mg of oxycodone.

Answer 45.9. The answer is D.

Although the exact mechanism is unclear, it is accepted that opioid anal-

gesics produce nausea and vomiting by action limited to the medullary

chemoreceptor trigger zone. Fortunately, tolerance frequently develops

to these side effects. Rotating opioids and adding antiemetics, such as

Compazine, are both effective in reducing or obviating this effect.

Answer 45.10. The answer is D.

Although there are many existential reasons that depression is common in

the terminally ill, physical factors can also produce symptoms of depres-

sion or mimic it. Corticosteroids can trigger psychosis, as well as depres-

sive symptoms. Hypercalcemia can result in an altered, depressed mood.

Uncontrolled pain, especially if prolonged, induces a sense of helplessness

and depression.

Answer 45.11. The answer is D.

Race, low socioeconomic status, and prolonged time in caring for the

patient have all been demonstrated to independently predict high rates of

primary caregiver burnout.

Answer 45.12. The answer is D.

Several studies have addressed the issue of professional barriers to effec-

tive cancer pain management. Surveys of oncologists demonstrated that

both inadequate knowledge and regulatory pressures contribute to inad-

equate analgesia in patients with cancer.