LWBK1006-45 LWW-Govindan-Review December 13, 2011 15:32
Chapter 45•Supportive Care and Quality of Life 567ANSWERS
Answer 45.1. The answer is D.
In addition to other professionals, such as social workers and school
counselors, the oncology team plays an important role in helping patients
explain to their children about their illness and prognosis. In 2002, Rauch
et al. (Rauch PK, Muriel AC, Cassem NH. Parents with cancer: Who’s
looking after the children? J Clin Oncol. 2002;20(21):4399–4402) pub-
lished recommendations that addressed this difficult issue. For school-
aged children, the guidelines include sharing information honestly, avoid-
ing euphemisms, encouraging the children to ask questions, and letting
them initiate the discussions.Answer 45.2. The answer is B.
This patient has neuropathic pain, in this case related to her treatment.
Although corticosteroids have a role in treating refractory neuropathic
pain, they are generally not used first line. Likewise, opioid drugs can be
useful, especially methadone, in more refractory settings and for severe
pain. However, neuropathic pain has a variable responsiveness to opi-
oids and may be less responsive than other types of pain. Most com-
mon drug classes used as first line for mild-to-moderate neuropathic
pain include antidepressants and anticonvulsants. Controlled trials of
gabapentin show 30% to 50% response rates in neuropathic pain. The
major adverse effect is sedation.Answer 45.3. The answer is A.
The two most common causes of insomnia in terminally ill patients are
pain and depression.Answer 45.4. The answer is B.
Dealing with situations when the oncologist believes treatment will do
more harm than good is very challenging for both the physician and the
patient. The key is in the words used and their implications, not just their
literal meanings. The goal is to convey a caring attitude and hope that her
quality of life will remain as good as possible, without making the patient
feel abandoned or unsure in regard to goals of therapy.Answer 45.5. The answer is A.
The procedure useful in refractory somatic or neuropathic pain from
tumor infiltration of the cranial nerves is rhizotomy. Cordotomy, thalam-
otomy, and mesencephalic tractomy are useful for unilateral pain below
the waist, unilateral neuropathic pain in the chest or lower extremity, and
pain in the nasopharynx or trigeminal region, respectively.Answer 45.6. The answer is D.
There are still many misconceptions regarding palliative care programs.
Unlike entering hospice care, patients do not need to change or abandon