Primary care for the declining cancer survivor
Asking yourself 1 question can help you to estimate an advanced cancer patient’s prognosis and determine how best to help in setting end-of-life priorities.
PRACTICE RECOMMENDATIONS
› Implement palliative/ supportive care shortly after the diagnosis of an incurable cancer. A
› Candidly communicate prognoses to patients and help them adjust their goals of care. B
› Recommend hospice care for patients who likely have less than 6 months to live, especially with treatmentrelated complications or significant caregiver stress. B
› Delay opioid therapy— if possible—to better control symptoms near the end of life. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Palliative sedation
Palliative sedation can manage intractable symptoms near the end of life. A recent systematic review suggests that palliative sedation does not shorten life.57 Sedation is most often initiated by gradual increases in medication doses.57 Midazolam is most often employed, but antipsychotics are also used.57
CORRESPONDENCE
CDR Michael J. Arnold, MD, Uniformed Services University of the Health Sciences, 4501 Jones Bridge Road, Bethesda, MD 20814; michael.arnold@usuhs.edu.
ACKNOWLEDGEMENT
Kristian Sanchack, MD, and James Higgins, DO, assisted in the preparation of this manuscript.
