Easing of Physical Distress in Pediatric Cancer
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Easing physical distress is a major focus in the practice of palliative care in a child with malignancy throughout the disease course from diagnosis to cure and survivorship or death.
Physical suffering is a main contributor to global suffering of the ill child, his parents, other family members, and also other persons involved.
Physical suffering is multifactorial and stems from many causes, mainly the disease itself, side effects of anticancer treatment and its consequences, as well as various painful procedures.
Physical distress reflects the body organ(s) involved in the disease, and therefore symptoms and, mainly, pain may vary widely in form, intensity, location, and its ability to interfere with the child’s daily activity and life.
Common types of physical distress are fatigue, pain, respiratory problems such as shortness of breath, gastrointestinal discomfort due to functional and mechanical obstruction, mucositis, and damage to central and peripheral nervous systems with accompanying alterations in conscience, seizures, and motor dysfunctions.
Timely recognition of the various signs and symptoms of physical distress allows the physician and other members of medical team to convey appropriate treatment to the suffering child with cancer. Easing the physical distress should be of paramount concern for all those involved in the management of pediatric oncologic patient at all levels of care: primary pediatrician in the community clinic, pediatric oncologist in the hospital ward, or specialist in pediatric palliative care both in hospital and in hospice service.
Proper and timely delivered pediatric palliative care directed at the easing of physical distress of pediatric cancer patient also greatly facilitates easing of both psychological distress and preserving the dignity of the child and the rest of his/her family members.
In this chapter we will describe in a detailed manner the use of various techniques for easing the pain and other forms of physical suffering using various pharmacological and non-pharmacological techniques. The pharmacological techniques will include intravenous, enteral, or topical drugs along with implementation of minimally invasive procedures such as various nerve blockades and insertion of epidural and other catheters to deliver site-specific or regional treatment. Non-pharmacological techniques will include procedures to ease physical distress such as pleurocentesis and paracentesis as well as ventilatory support with high-flow nasal cannula and noninvasive positive pressure ventilation.
Management of symptoms related to the central nervous system as seizures, depressed levels of consciousness, and symptoms originating from dysfunction of pelvic organs (neurogenic bladder and rectum) is also discussed. Spinal cord compression, almost the only emergency condition encountered in children with cancer during the last phases of their lives, needs special attention, and therefore its diagnosis and management are also reflected in this chapter.
Although detailed discussion of palliative sedation as a mean of last resort in the management of unbearable suffering is beyond the scope of this chapter, its role in the easing of physical distress is shortly mentioned.
KeywordsPhysical Distress High-flow Nasal Cannula (HFNC) Pediatric Palliative Care Palliative Sedation Pediatric Cancer Patients
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