Summary
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.
Similar content being viewed by others
References
Higginson IJ, Gomes B, Calanzani N, Gao W, Bausewein C, Daveson BA, et al. Priorities for treatment, care and information if faced with serious illness: a comparative population-based survey in seven European countries. Palliat Med. 2014;28(2):101–10.
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3(11):e442.
Sleeman KE, de Brito M, Etkind S, Nkhoma K, Guo P, Higginson IJ, et al. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions. Lancet Glob Health. 2019;7(7):e883–e92.
Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, Grambow S, Parker J, et al. Preparing for the end of life: preferences of patients, families, physicians, and other care providers. J Pain Symptom Manage. 2001;22(3):727–37.
Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J, et al. A systematic review of physicians’ survival predictions in terminally ill cancer patients. BMJ. 2003;327(7408):195–8.
Gwilliam B, Keeley V, Todd C, Gittins M, Roberts C, Kelly L, et al. Development of Prognosis in Palliative care Study (PiPS) predictor models to improve prognostication in advanced cancer: prospective cohort study. BMJ Support Palliat Care. 2015;5(4):390–8.
Stone P, Gwilliam B, Keeley V, Todd C, Gittins M, Kelly L, et al. Patients’ reports or clinicians’ assessments: which are better for prognosticating? BMJ Support Palliat Care. 2012;2(3):219–23.
Hui D, Maxwell JP, Paiva CE. Dealing with prognostic uncertainty: the role of prognostic models and websites for patients with advanced cancer. Curr Opin Support Palliat Care. 2019;13(4:360–8.
Sepúlveda C, Marlin A, Yoshida T, Ullrich A. Palliative care: the World Health Organization’s global perspective. J Pain Symptom Manage. 2002;24(2):91–6.
Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline update. J Clin Oncol. 2017;35(1):96–112.
Kaasa S, Loge JH, Aapro M, Albreht T, Anderson R, Bruera E, et al. Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol. 2018;19(11):e588–e653.
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.
Skelton L, Guo P. Evaluating the effects of the pharmacological and nonpharmacological interventions to manage delirium symptoms in palliative care patients: systematic review. Curr Opin Support Palliat Care. 2019;13(4):384–91.
Neufeld KJ, Yue J, Robinson TN, Inouye SK, Needham DM. Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2016;64(4):705–14.
Gaertner J, Eychmueller S, Leyhe T, Bueche D, Savaskan E, Schlogl M. Benzodiazepines and/or neuroleptics for the treatment of delirium in palliative care?—a critical appraisal of recent randomized controlled trials. Ann Palliat Med. 2019;8(4):504–15.
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.
Lokker ME, van Zuylen L, van der Rijt CC, van der Heide A. Prevalence, impact, and treatment of death rattle: a systematic review. J Pain Symptom Manage. 2014;47(1):105–22.
Mercadante S, Marinangeli F, Masedu F, Valenti M, Russo D, Ursini L, et al. Hyoscine butylbromide for the management of death rattle: sooner rather than later. J Pain Symptom Manage. 2018;56(6):902–7.
Cherny NI. Sedation for the care of patients with advanced cancer. Nat Clin Pract Oncol. 2006;3(9):492–500.
Cherny NI. ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Ann Oncol. 2014;25(Suppl 3):iii143–iii52.
Cherny NI, Radbruch L. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med. 2009;23(7):581–93.
Maltoni M, Scarpi E, Rosati M, Derni S, Fabbri L, Martini F, et al. Palliative sedation in end-of-life care and survival: a systematic review. J Clin Oncol. 2012;30(12):1378–83.
Hasselaar JG, Reuzel RP, Verhagen SC, de Graeff A, Vissers KC, Crul BJ. Improving prescription in palliative sedation: compliance with dutch guidelines. Arch Intern Med. 2007;167(11):1166–71.
Reuzel RP, Hasselaar GJ, Vissers KC, van der Wilt GJ, Groenewoud JM, Crul BJ. Inappropriateness of using opioids for end-stage palliative sedation: a Dutch study. Palliat Med. 2008;22(5):641–6.
Bausewein C, Simon ST, Pralong A, Radbruch L, Nauck F, Voltz R. Palliative care of adult patients with cancer. Dtsch Ärztebl Int. 2015;112(50):863–70.
Simon ST, Koskeroglu P, Bausewein C. Pharmacological therapy of refractory dyspnoea: a systematic literature review. Schmerz. 2012;26(5):515–22.
Strieder M, Pecherstorfer M, Kreye G. Symptomatic treatment of dyspnea in advanced cancer patients: a narrative review of the current literature. Wien Med Wochenschr. 2018;168(13–14):333–43.
Simon ST, Higginson IJ, Booth S, Harding R, Weingartner V, Bausewein C. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev. 2016;10:Cd7354.
Sjogren P, Thunedborg LP, Christrup L, Hansen SH, Franks J. Is development of hyperalgesia, allodynia and myoclonus related to morphine metabolism during long-term administration? Six case histories. Acta Anaesthesiol Scand. 1998;42(9):1070–5.
Wright AW, Mather LE, Smith MT. Hydromorphone-3-glucuronide: a more potent neuro-excitant than its structural analogue, morphine-3-glucuronide. Life Sci. 2001;69(4):409–20.
Lee KA, Ganta N, Horton JR, Chai E. Evidence for neurotoxicity due to morphine or hydromorphone use in renal impairment: a systematic review. J Palliat Med. 2016;19(11):1179–87.
Clemens K, Klaschik E. Morphin und Hydromorphon bei Palliativpatienten mit Niereninsuffizienz. Anästh Intensivmed. 2009;50:70–6.
Felden L, Walter C, Harder S, Treede RD, Kayser H, Drover D, et al. Comparative clinical effects of hydromorphone and morphine: a meta-analysis. Br J Anaesth. 2011;107(3):319–28.
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.
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.
Muttoni S, Ardissino M, John C. Classical psychedelics for the treatment of depression and anxiety: a systematic review. J Affect Disord. 2019;258:11–24.
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.
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.
Nipp RD, El-Jawahri A, Fishbein JN, Eusebio J, Stagl JM, Gallagher ER, et al. The relationship between coping strategies, quality of life, and mood in patients with incurable cancer. Cancer. 2016;122(13):2110–6.
Benkel I, Wijk H, Molander U. Using coping strategies is not denial: helping loved ones adjust to living with a patient with a palliative diagnosis. J Palliat Med. 2010;13(9):1119–23.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
G. Kreye, B. Heidecker, and E.K. Masel declare that they have no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kreye, G., Heidecker, B. & Masel, E.K. The top ten things that must be known about end of life therapy in patients with advanced cancer. memo 13, 88–92 (2020). https://doi.org/10.1007/s12254-020-00572-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12254-020-00572-6