A Successful Palliative Care Intervention for Cancer Pain Refractory to Intrathecal Analgesia

Interventional anesthesia and palliative care collaboration to manage cancer pain: a narrative review

“…Before the procedure is offered, an exploration of a patient's goals of care is strongly recommended to confirm that interventional procedures and potential adverse effects are acceptable. 65 Patients should be aware that serious iatrogenic complications, such as catheter migration, can occur. Therefore, decisions about resuscitation (or code) status should be discussed in this context.…”

“…Patients and teams should be aware that end-of-life disposition options may be limited as most PCU and community palliative care teams will not be familiar with management of neuraxial infusions. 58,65 Specialized training is required to ensure palliative care teams are competent and have the technical expertise to safely care for patients. 58,59 Maintaining this expertise can be challenging given the low percentage of patients who are candidates for the procedure.…”

“…These reservoirs are refilled with medication monthly. 65 Although the initial cost of placement is high, maintenance costs are lower and can save costs compared with the hospital, pharmacy, and healthcare provider fees associated with oral and intravenous medication and related adverse effects. 64,66,67 Despite the potential for an overall costsaving when implanted in appropriate patients, availability is an ongoing challenge in many centres.…”

Pancoast’s syndrome caused by lymph node metastasis from breast cancer

“…If oral therapy fails or intolerable side effects to systemic opioids develop, intrathecal analgesia has been proposed as a therapeutic option 14. Although there are potential benefits, this technique has dangerous complications due to catheter insertion, including cerebrospinal fluid leakage, which is usually managed with an epidural blood patch 15.…”

Acute Palliative Care Units

“…Acute palliative care units, where palliative care assumes the role of the primary medical team, have been shown to be superior to palliative care consultation services in terms of serving the needs of patients at the end of life. 6 Acute palliative care units are highly successful at controlling refractory physical and psychosocial distress in patients and their families and thereby facilitate discharge from the hospital, prevent intensive care unit admissions, and provide cost-effective acute care. 2Y5 Acute palliative care units can also address important internal medicine issues at the same time that they deliver expert palliative careVfor example, some of the complex interventions that are done on a regular basis in APCUs are imaging studies, active consultations with other medical specialties, evaluation and treatment of infections, placement of intraperitoneal catheters, venting gastrostomy tubes, intrapleural catheters, and blood transfusions.…”