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Tuesday, December 7, 2010

End of Life Issues

The news that Elizabeth Edwards’ cancer has returned and that no further treatment is recommended has many people asking questions. We asked the WebMD Facebook audience what questions this situation raised for them, and resident expert Laura Martin, MD, gave answers.

What makes a doctor not recommend further treatment? Does that mean it’s time to give up?

In patients with terminal diseases such as end-stage metastatic cancer, there may not be any possibility of a cure. There may be therapies that extend the amount of time a patient has left to live. But sometimes there are no more therapies that have been shown to extend life significantly. At that point the doctor may not recommend further treatment.

Even though there may be no further recommended treatment, doctors and caregivers can continue to treat symptoms and pain from the disease, called palliative care.

What is palliative care?

Palliative care is an approach to medical care where the focus is on pain and symptom management along with psychosocial and spiritual concerns. Palliative care is commonly considered in patients who have been diagnosed with a life-threatening illness where there may not be curative treatments. The goal of palliative care is to provide the best quality of life possible in patients with a serious medical illness.

What kind of medication can make a patient comfortable? Can they be given too much?

There are many medications available to treat pain. As with any medication, side effects are possible. In patients with pain from cancer, often opioid medications such as morphine are prescribed. Opioids can have significant side effects that include nausea, constipation, sedation, and in some cases respiratory depression. It is important to take these medications at the recommended doses prescribed by your doctor.

When doctors tend to wait to the very end to say there is no cure, are they giving loved ones false hope?

The role of doctor-patient communication is very important in medical care. In patients with life-threatening illnesses it is often helpful to have a discussion about progression of the disease and life expectancy. If a patient desires, a family meeting including the doctor, patient, family, and friends can be helpful.

Posted by: WebMD Blogs at 10:07 am

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