Cancer care of the terminally ill patient in the emergent care setting

Care of the terminally ill patient in the emergent care setting requires a mental adjustment for most health care providers. We are acutely aware of the needs of patients presenting with urgent life sustaining needs but what about those arriving in the emergent setting with end of life needs?

For the most part cancer patients opt to fulfill their end of life needs in the privacy of their homes but occasionally they require emergent care and seek emergency rooms for life sustaining treatment even though their condition has been determined terminal by medical standards.

- Patients with cancer often have compromised immune systems and a Neutropenic fever can signal serious but treatable infections.

- Obstructive or compression complications where metastatic tumor growth impinges on nearby organs and structures requires immediate attention.

- Metabolic crisis where life sustaining electrolytes are out of balance requiring immediate replacement.

- Cytopenic crisis where patients present with thrombocytopenic crisis and acute autoimmune anemia situations requiring immediate administration of treatment.

- Severe pain control for those whose disease is not responsive to a curative treatment but rather for administration of intense comfort measures during end of life.

To be free of avoidable pain and suffering for the cancer patient and patient’s family is a priority and it would seem the acute care setting is not the most favorable choice for this treatment but approximately 30% of cancer patients fear dying at home and seek additional end of life measures through the emergency room for treatment of acute illnesses superimposed on the existing cancer and usually for the control of pain and symptoms.

Palliative care for cancer patients can also be addressed in the acute care setting by managing pain and comfort control, acute respiratory issues, nausea/vomiting, anxiety/depression, family supportive needs, and impending death issues.



Care of the end of life patient in the emergent setting has a significant impact on the dying patient and their families and as front-line caregivers we must strive to be supportive, compassionate and empathetic. There are many available resources for palliative care. Please follow the links provided for additional information.

Palliative care guide links

http://cme.medscape.com/viewarticle/568751

http://www.getpalliativecare.org/

http://dying.about.com/od/whatispalliativecare/a/whatisPC.htm