Palliative Care In Prostate Cancer : The Relief Of Symptoms And Other Measures

 Palliative care in prostate cancer

The relief of symptoms and other measures to enable a patient with incurable, progressive prostate cancer independent living, as far and as long as this allows the disease.

The palliative care is to improve the quality of life of patients (and their families), at whose disease no curative (healing), but only an even palliative (palliative) treatment is possible. This is done by prevention of physical, psychological, social and spiritual problems and their resolution or relief. This definition (according to WHO 2002) is very comprehensive and can not recognize that the care is provided by a whole team, from doctors to counselors, and this until the death of the sick also. To discuss all aspects here, would be much too detailed. Therefore, hereinafter particularly medical policies were identified in addition be made ​​to the "More Information" section (see below).

According to current treatment guidelines, the goal of palliative therapy in patients with advanced prostate cancer improving their quality of life through effective treatment of stressful symptoms. Often there is therefore in this case, pain, fatigue (Fatigue), weight loss, anxiety, depression and discomfort to affected organs (eg, urinary retention below).

The possibilities of palliative therapy should be discussed early and in detail according to the guideline with the patient and his family. This includes information on all available care services and treatment methods as well as the creation of a comprehensive treatment plan. The latter is to be determined (with the participation of people from different disciplines) taking into account the wishes of the patient and interdisciplinary. Patients should an interdisciplinary treatment team of specially trained staff are available. This is physical and emotional symptoms such as anxiety, restlessness, depression, shortness of breath, weakness, and fatigue (Fatigue) regularly gather and manage and treat the patient appropriately.
Supportive

This is understood in general supportive treatment that is directed against side effects and complications of other therapies. Accordingly, many different measures can ensure there are suitable. Examples can be found in Sections radical prostatectomy , radiotherapy and hormone therapy .
Relocation of the urinary tract

An advanced tumor itself as well as lymph nodes and other metastases can the outflow of urine in the urethra , the bladder , or ureter affect. Possible consequences include problems with urination, ascending urinary tract infections, general infections (sepsis) and permanent damage to the kidneys.

In patients with subacute (with less intense running) urinary obstruction, for which no hormone therapy has been carried out, should be done first only such treatment (see hormone therapy). In patients with urinary obstruction that causes symptoms, is to be a urinary diversion: It is possible by means of the catheter (of the kidney to the bladder, from the bladder through the urethra or of the bladder or kidney = percutaneously through the skin to the outside) by means of stent (at the constriction in the urethra or the ureter pickled tube) and means of operation (eg, with a possibly minimal TURP or laser ablation of the prostate, similar to the procedures used to treat benign prostate enlargement, see surgical procedure for BPH treatment ).

The possibility of urinary diversion, their advantages and disadvantages as well as the various procedures should be discussed with the patient and his relatives. Patients with androgen-independent (castration-resistant) prostate cancer (see hormone therapy ) and a two-sided hydronephrosis usually have a short life expectancy, and this should be taken into account when deciding on a urinary diversion.

Because of the disadvantages of other methods, the urine drainage should preferably be percutaneously (through the skin). Subsequently, the patient should be monitored during the first month several times, further checks should be performed monthly.
Bone complications

Metastases of prostate cancer are preferably found in the skeleton (see the growth and spread). There, they can cause pain, interfere with the formation of blood and surrounding organs and lead to instability of bone (eg breakage, deterioration of the spinal cord). Instability can also be the result of bone loss (osteoporosis) by a prolonged hormone therapy be (see for treatment there ).

For the palliative treatment of bone metastases are available: pain treatment (see next section), hormone therapy , chemotherapy , local irradiation (possibly combined with surgery), use of radionuclides (radioactive substances) and administration of so-called bisphosphonates or denosumab (a artificial monoclonal antibody against an antigen on certain bone cells).

A local percutaneous radiotherapy (local irradiation of the skin) to be taken when an impairment (compression) threatens the spinal cord or if the fracture risk is increased. Such treatment should be offered if local bone pain persist under a general medical treatment (hormone therapy).

Radionuclides (Sr-89, Sm-153 or Re-186) can be used if in a hormone (hormone-insensitive) prostate cancer multiple bone metastases are present and can treat the pain adequately.

In an androgen-independent (castration-resistant) prostate cancer (see hormone therapy ) should be offered to prevent against complications of bone metastases according to information about the benefits and risks of bisphosphonate zoledronic acid or as the monoclonal antibody denosumab. Because of possible side effects on the jaw bone, the patient should previously examined by the dentist to treat and can guide to optimal oral hygiene.Whether bisphosphonates are also for the prevention of bone metastases itself, is still unclear.
Pain

In far advanced prostate cancer often occur pain, by the tumor itself, its metastases, or for other reasons. The treatment may be causally (directed against the cause, such as targeted radiation or surgery of metastases) be. It is usually symptomatic (directed against the signs of disease, such as medication, physical therapy, stimulation or blockade of nerve tissue, aids like corsets).

After a careful diagnosis initially come measures against remediable causes of pain to train (eg by laying the urinary tract, bone complications so). The pharmacological pain therapy should be given after the staging system of the WHO (World Health Organization, World Health Organization). Using different painkillers (analgesics, including opioids such as morphine) and supporting substances (co-analgesics and adjuvants, such as psychotropic drugs, anticonvulsants, corticosteroids). In addition, should not be considered medical measures that can alleviate the pain, such as physical (eg storage, lymphatic drainage, activating care) and psychosocial methods (psychological and pastoral assistance). Also helpful are certain psychotherapeutic techniques such as progressive muscle relaxation or behavioral therapy.
Gastrointestinal complaints

Nausea (feeling sick) and vomiting (emesis), not only from a radiotherapy and chemotherapyare triggered, but with an extended prostate cancer for example, by metastasis, a metabolic disorder (eg, bone disease or kidney damage) and medication (eg painkillers). You get treated with medication. If possible, however, a causal therapy preferable as the local irradiation of a metastasis or the elimination of the trigger (eg converting the painkiller). Psychotherapeutic techniques can be supportive.

Constipation (constipation) may have similar reasons and is often exacerbated by lack of exercise and changing eating and drinking habits. If the cause can not be eliminated, Laxatives (laxatives) are given. For mechanical installation of the intestine (eg, narrowing of the rectum by the tumor) and intestinal paralysis (ileus) may come into question an operation.
Difficulty breathing

Possible causes of cough and shortness of breath (dyspnea) are also very numerous. The treatment is also possible causal , otherwise symptomatic , for example, with medication, physical therapy, such as humidifying the air we breathe or respiratory therapy, by addition of oxygen and psychotherapeutic methods.
Unconventional methods of treatment

In the above mentioned complaints and methods of alternative medicine such as nutritional therapy can be supportive. , Refer to the previous section, Unconventional methods of treatment for prostate cancer.
Palliative sedation

Persists in the final stages of the disease despite maximum possible therapy unbearable physical or mental suffering, sedation (sedative) with drugs is possible. The impairment of consciousness can be controlled, so does not necessarily loss of senses such as hearing or vision. Whether this possibility comes for him in consideration, the patient should discuss with his doctor in time.
Psycho-oncological support

The diagnosis of cancer can affect the emotional and social lives of those affected considerably. Psycho-oncologists (psychosocial oncologists) are specially trained in this area accompany doctors or psychologists, cancer patients and their families, advice and treatment.The goal is to assist them in coping with the disease to help reduce physical symptoms (eg pain) and mental stress and improve quality of life. The clinician should ask for relevant problems and, if appropriate, offer or give a psycho-oncological support.
Important rules in time

Nobody likes to deal with his own death. However, it makes it easier to say goodbye when the important things are regulated. Therefore, it is best to make provisions in time of giving rise to, for example, no doubt as to the testamentary capacity (eg when issuing a power of attorney) or to miss your deadline (eg playing in some annuities, the duration of a marriage for the pension claim a role).

It is advisable to issue important documents and organize records and to ensure that a person of trust has access to it (take note with the repository or locker key with him or hand over to the person). Examples:

    Advance directive (living will): What is to be done medically in which case too, if you even can not decide.
    Services available: who is to be appointed as a supervisor, if one is incapable of decision.
    Vorsorgevollmacht: Who should the extent to which over personal matter (eg care, assets) get power of attorney, if one is incapable of decision.
    Testament: Hand or at the notary.
    Directory and records of accounts and assets: Possibly. the will enclose.
    Postal and banking power of attorney: Choose Beyond death effective form.
    Badges and certificates: For example, identity card, passport, birth certificate, marriage certificate, family book, divorce decree, death certificate of the partner.
    (Check Eligibility) For example, health insurance (including map), pension (including last assessment), life insurance, accident insurance, funeral insurance: Directory and documentation of insurance.
    Directory and documentation of contracts: for example, lease, funeral pension agreement.