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Salivary duct carcinomas (SDCs) are aggressive rare neoplasms. Whose diagnosis and treatment are a clinical challenge to both the treating doctor as well as the pathologist. Primary surgery with or without neck dissection followed by adjuvant radiation treatment is preferred for those with localized SDCs. Even with localized disease, the 5-year survival is <30%. For metastatic disease, the treatment options are limited. Two important biomarkers identified in SDCs are androgen receptors (ARs) and human epidermal growth factor receptor 2 receptors. Androgen deprivation therapy has evolved from the treatment of prostatic malignancies and various androgen-targeted agents are already in use for prostatic cancers. This case study represents the successful treatment of a metastatic SDC of the submandibular gland with AR-targeted agents. This patient has undergone treatment with multiple lines of Androgen targeted agents which is still ongoing. The main Androgen targeted agents used in this particular patient are Abiraterone and Enzalutamde. The patient has already achieved a disease-free survival of 30 months. Further studies have to be conducted to target ARs and more agents need to be tried.

Background 15-20% of critical care patients die during their hospital admission. This service evaluation assesses the quality of palliative care on ICUs compared to national (NICE) standards, and which triggers identify palliative care needs. Methods Retrospective service evaluation, using records review for all patients who died in four ICUs, between 1 June and July 31 2019. Descriptive statistics were reported for patient characteristics, length of stay, admission route, identification triggers, and palliative care delivery. Results N=43. Death was recognised in 88% (38). Among those in which dying was recognized (N=35), 97%(34) had a documented family discussion before death, 9%(3) were offered religious/spiritual support, 11%(4) had review of hydration/nutrition, 6%(2) had documented preferred place of death. Prescription of anticipatory medications was complete in 71%(25) opioids, 34%(12) haloperidol, 54%(19) midazolam, 43%(15) hyoscine. Combining five triggers-length of stay >10 days prior to ICU admission 7%(3), multi-organ failure ‰¥3 systems 33%(14), stage IV malignancy 5%(2), postcardiac arrest 23%(10), and intracerebral haemorrhage requiring mechanical ventilation 12%(5)-identified 60%(26) of patients. 14%(5) were referred to the palliative care team, and 8%(3) had specialist palliative care team review. Conclusions Recognition of dying was high, but occurred close to death. Standard of end of life care was good in terms of family discussion, but religious/spiritual needs, review of hydration/nutrition, and prescription of anticipatory medications were less often considered. The ICUs delivered palliative care using a mainly 'integrative' model. Combining five triggers may increase identification of palliative care needs, but a larger study is needed.