Palliative treatment options

• Drug therapy e.g. morphine
• Non-drug therapy including MDT input
• Interventions
  • Surgical resection
  • Drainage of pleural or peritoneal fluid
  • Vertebroplasty

Breathlessness

• Concept of ‘neuromechanical dissociation’ - mismatch between intended and experienced effort of breathing
• Different types of breathlessness may be related to different mechanisms

Management

• Oxygen is a treatment for hypoxia, not breathlessness
• Reverse what you can (e.g. pleural effusion)
• Non-pharmacological:
  • Breathing exercises/pacing
  • Physiotherapy
  • Relaxation exercises
  • Handheld fan
• Pharmacological:
  • Low dose morphine first line
  • Consider low dose benzodiazepines e.g. midazolam
  • Long term oxygen if hypoxic

Pain management

WHO analgesic ladder

Adjuvant analgesics

• Painkillers whose primary indication is for something other than pain
• Anticonvulsants - gabapentin, preganalin
• Antidepressants - amitriptyline, dulozetine
• Choice influenced by patient factors and side effect profile e.g. amitriptyline is good for neuropathic pain and also has a sedating effect