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Managing common end-of-life cancer presentations according to the evidence

02 May 2019
Volume 11 · Issue 5

Abstract

The ambulance service is increasingly being called to patients suffering from cancer who are near the end of their lives. This presents challenges to clinicians who may not be confident in the management of symptoms near the end of life. The approach to, and management of, these types of patients often requires different considerations to more traditional emergency calls. This article reviews the evidence around the management of common cancer presentations at the end of life. In particular, it will consider the psychological effects of a terminal diagnosis, management of breakthrough pain, breathlessness and neutropenic sepsis.

Ambulance service personnel regularly come into contact with patients who are approaching the end of their lives—many more calls than ambulance services traditionally attended. This group of patients also tends to present in the out-of-hours period where support from specialist services is extremely limited. End-of-life cancer presentations often require a specialist approach, problem-solving skills and increased knowledge of the specific issues that may arise.

The Gold Standards Framework (Royal College of General Practitioners, 2011) considers that patients are approaching the end of their life when they are likely to die within the next 12 months. In order to ascertain this, it encourages relevant health professionals to ask themselves the ‘surprise question’: Would I be surprised if this patient were to die within the next 12 months? If not, they are considered ‘end-of-life’. This provides the context for the types of patients living with cancer whose care will be discussed in the current article.

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