The top ten things that must be known about end of life therapy in patients with advanced cancer
End of life is an issue that affects every human being sooner or later. Several aspects at the end of life should not be neglected to achieve good symptom control. Basic knowledge and skills on symptom control and palliative care are important to support patients in this threatening phase of their life. Palliative care should not be provided only at the end of life. The concept of early integration of palliative care is increasingly coming into focus. Nevertheless, at the end of life there are some important facts and issues that should be taken into account. This short article provides a list of ten important facts at the end of life that are important for the authors. Prognostication, early integration, benzodiazepines, death rattle, palliative sedation, standard therapy for refractory dyspnea, opioids in renal failure, psylocibin, denial and reduction of drugs at the end of life will be discussed in detail.
KeywordsEarly integration Relevant symptoms at the end of life Psychedelic prodrug Medication at the end of life
Conflict of interest
G. Kreye, B. Heidecker, and E.K. Masel declare that they have no competing interests.
- 12.Vanbutsele G, Van Belle S, Surmont V, De Laat M, Colman R, Eecloo K, et al. The effect of early and systematic integration of palliative care in oncology on quality of life and health care use near the end of life: a randomised controlled trial. Eur J Cancer. 2020;124:186–93.PubMedCrossRefGoogle Scholar
- 16.Hui D, Frisbee-Hume S, Wilson A, Dibaj SS, Nguyen T, De La Cruz M, et al. Effect of lorazepam with haloperidol vs haloperidol alone on agitated delirium in patients with advanced cancer receiving palliative care: a randomized clinical trial. JAMA. 2017;318(11):1047–56.PubMedPubMedCentralCrossRefGoogle Scholar
- 32.Clemens K, Klaschik E. Morphin und Hydromorphon bei Palliativpatienten mit Niereninsuffizienz. Anästh Intensivmed. 2009;50:70–6.Google Scholar
- 34.King S, Forbes K, Hanks GW, Ferro CJ, Chambers EJ. A systematic review of the use of opioid medication for those with moderate to severe cancer pain and renal impairment: a European Palliative Care Research Collaborative opioid guidelines project. Palliat Med. 2011;25(5):525–52.PubMedCrossRefGoogle Scholar
- 35.Douglas C, Murtagh FE, Chambers EJ, Howse M, Ellershaw J. Symptom management for the adult patient dying with advanced chronic kidney disease: a review of the literature and development of evidence-based guidelines by a United Kingdom Expert Consensus Group. Palliat Med. 2009;23(2):103–10.PubMedCrossRefGoogle Scholar
- 37.Ross S, Bossis A, Guss J, Agin-Liebes G, Malone T, Cohen B, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol. 2016;30(12):1165–80.PubMedPubMedCentralCrossRefGoogle Scholar
- 38.Griffiths RR, Johnson MW, Carducci MA, Umbricht A, Richards WA, Richards BD, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: a randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181–97.PubMedPubMedCentralCrossRefGoogle Scholar