Internal Medicine Issues in Palliative Cancer Care

Patients with advanced cancer may develop a number of clinical complications related to tumor progression or a variety of aggressive treatments. The majority of these patients are elderly, often with multiple co-morbidities that require appropriate assessment and management. In the palliative stage of their disease, patients undergo a progressive transition from active acute care to community-based hospice care. This transition requires modification in the diagnostic tests, monitoring procedures and pharmacological treatments to adjust them to the palliative and short-term nature of the care. Internal Medicine Issues in Palliative Cancer Care looks at internal medicine through a prognosis-based framework and provides a practical approach to maximizing comfort and quality of life while minimizing aggressive investigations and therapies for patients with life-limiting disease. Forty-six common internal medicine conditions are organized into nine clinical categories: pulmonary, cardiovascular, nephrologic and metabolic, gastrointestinal, hematologic, infectious, endocrine, rheumatologic, and neuro-psychiatric. This evidence-based resource is ideal for educating clinicians delivering palliative care to cancer patients in acute care facilities about complex internal medicine problems, decision-making regarding diagnostics and therapeutics which require a good understanding of state-of-the-art internal medicine and palliative care principles. David Hui, Assistant Professor, Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, USA, and Eduardo Bruera, Professor, Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, USA CONTENTS 1. Introduction 1.1. Principles of Internal Medicine in Palliative Care 1.2. Principles of Prognostication 1.3. Principles of advance care planning 2. Pulmonary 2.1. Chronic Obstructive Pulmonary Disease 2.2. Pleural Effusion 2.3. Pulmonary Embolism 2.4. Non-invasive ventilation 3. Cardiovascular 3.1. Heart Failure 3.2. Acute Coronary Syndrome 3.3. Pericardial Effusion and Tamponade 3.4. Arrhythmias 3.5. Arterial Hypertension 3.6. Dyslipidemia 4. Nephrology and Metabolic Abnormalities 4.1. Chronic Kidney Disease & Acute Kidney Injury 4.2. Urinary Incontinence 4.3. Urinary Retention 4.4. Hematuria 4.5. Metabolic acidosis 4.6. Electrolyte abnormalities (Na, K, Mg) 4.7. Hypercalcemia 5. Gastrointestinal 5.1. Upper and Lower Gastrointestinal Bleeding 5.2. Acute and Chronic Diarrhea 5.3. Bowel Obstruction 5.4. Liver Failure and Hepatitis 5.5. Biliary Obstruction 5.6. Pancreatitis 6. Hematological Disorders 6.1. Anemia 6.2. Neutropenia 6.3. Thrombocytopenia 6.4. Bleeding Disorders 6.5. Deep Vein Thrombosis 7. Infections 7.1. Sepsis 7.2. Pneumonia 7.3. Urinary Tract Infections 7.4. Osteomyelitis 7.5. Skin Infections 7.6. Herpes Infections 7.7. Fungal Infections 8. Endocrine 8.1. Diabetes 8.2. Hyperthyroidism 8.3. Hypothyroidism 9. Rheumatology 9.1. Arthritis 10. Neuro-psychiatric 10.1. Acute Stroke Syndrome 10.2. Seizures 10.3. Syncope 10.4. Migraines 10.5. Dementia 10.6. Vitamin B12 deficiency 10.7. Parkinson's Disease