From OHC

July 8, 2013

Bechhold Rebecca MD - NEW PHOTO Blog Inset

Co-author Rebecca Bechhold, MD, practices medical oncology, hematology and palliative care at OHC

OHC believes all patients deserve the best quality of life that we, as physicians, can help them achieve. Discussing a plan of care with patients at the beginning of treatment, particularly for a chronic disease, is key to showing them that their personal goals are a priority. An effective plan should include steps that can be taken to alleviate pain, nausea and other stressful symptoms patients may face during their journey.

These efforts to assist patients in symptom management arise from the palliative care model. However, because many connote palliative care with end-of-life care, we prefer the name “Supportive Care” since we believe all patients, whether they are being treated for a curative disease, chronic disease or end-of-life disease should be screened and assisted with proper symptom management. Serving the needs of the whole patient, not just the particular disease is key.

Below are steps for effective symptom management, which may assist a primary care or specialty care physician in caring for the whole patient. These are considered best practices by OHC and our board-certified experts in palliative / supportive and hospice care:

  • To treat pain, work with one drug only. It is easier to dose and titrate single agents such as oxycodone and morphine. Avoid combination drugs, such as those with acetaminophen.
  • When long-acting drugs are prescribed, plan for supplemental doses to help patients cope with breakthrough pain.
  • Haldol is the preferred treatment for nausea, but note that Haldol cannot be used to treat those diagnosed with Parkinson’s disease.
  • Lorazepam is a good adjunct to narcotics for pain.
  • Always use aggressive laxatives with narcotics to assure the patient’s comfort.

    Dr. Prasad Kudalkar co-authored this article with Dr. Rebecca Bechhold.

    Co-author Prasad Kudalkar, MD, practices medical oncology and hematology, neuro-oncology and palliative care at OHC

  • Know what you’re treating. Conditions such as urinary retention can cause agitation that may masquerade as pain.
  • Understand narcotic neurotoxicity. Patients with hallucinations or myoclonic jerking can be switched to another narcotic, which should alleviate symptoms.
  • If you’re chasing pain with higher narcotic doses without seeing relief, your patient may not be absorbing the drug properly. Consider changing the route of administration. Begin at a much lower dose and titrate upward to achieve relief.

OHC’s Supportive Care experts are available to discuss symptom relief and end-of-life care so patients can enjoy each day with greater comfort, freedom and dignity. We have seen many patients live more comfortably by opting to limit chemotherapy and embrace palliative care for continuing symptoms. As physicians, we need to put patients first and support their right to choose the best care. Our job is to provide the information and support patients’ needs to make confident decisions.

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