Explain Palliative care of patient with gastric cancer

Prepared by Urmila Prajapati

MN 2nd year
Roll no 12
 Palliative care
• Palliative care is philosophy of care that focuses on patient comfort and quality of life
rather than curing the patient disease.

• Palliative care focus on preventing, managing and relieving the symptoms of cancer and
its side effect of treatment.

• Palliative care is not only for the person with cancer it also include support for care giver
and children of people of cancer. Care giver can also experience stress anxiety depression.
Palliative care can help care giver providing balance care and improve their quality of life.

• The mission of palliative care is to affirm life and view death as a natural process .

• Palliative care is not design to hasten or postpone death.

 cont
• Palliative care is defined as the active total care of patient whose disease is not response to
curative treatment.

• Multidisciplinary team work together to provide palliative care. eg physician, nurses,

social workers, pharmacist, physiotherapist, nutritionist, spiritual advisor etc

• WHO define Palliative care is an approach that improves the quality of life of patients and
their families facing the problem associated with life-threatening illness, through the
prevention and relief of suffering by means of early identification and impeccable
assessment and treatment of pain and other problems, physical, psychosocial and spiritual. 
cont
• Palliative care vary widely and often include medication, nutritional change,
relaxation technique, emotional and spiritual support and other therapy.

• Cancer and its treatment cause physical symptoms and side effect as well as
emotional, social and financial effect . Managing all these effect is called palliative
care.

• Palliative care should be initiated right after cancer diagnosis to optimize the benefit
till bereavement.

• Palliative care can help to understand the choice of modality of treatment.

 cont

• Palliative care can help treat late side effect of cancer treatment. Eg lymphedema

• People receive palliative care along with treatment for cancer often have less sever
symptoms, better quality of life and more satisfied with treatment.
Principle of palliative care

• Patient and family is the unit of care

• Attention to the physical psychological, social and spiritual needs must be

included

• Interdisciplinary team is involved in the care.

Goal of palliative care

• To achieve the highest quality of life for patient and their family

• Focus on a person as a whole and offer a wide range of support, service to the ill
person.

• Offer bereavement support and can help the family work through emotion and
grief regarding the illness and death a love one.
Gastric cancer

• Gastric cancer is also called malignant tumor of the stomach. Most of the cancer
in stomach is adenocarcinoma (90-95%). These cancers develop from the cells
that form the mucosal lining of the stomach.

• Stomach cancer is the fourth most commonly occurring cancer in men and the
seventh most commonly occurring cancer in women
 Treatment of gastric cancer

• Surgery: may be curative or palliative to relief from obstruction in advance stage

• endoscopic mucosal resection

• Subtotal gastrostomy

• Total gastrostomy

• Radiation therapy: the management of stomach cancer is for the palliative of

symptoms. Radiation therapy with chemotherapy has become the gold standard
of adjuvant therapy for resected stomach.

• Chemotherapy is the treatment modality for the patient with residual disease
after primary resection .
Palliative care in gastric cancer

• At the time of diagnosis, counselling is the most important part of palliative care. Counselling about the stage of
disease, treatment modality, side effect of treatment, financial support. It relieve the anxiety both patient and
family.

• If patient is going to chemotherapy, advice about hair fall and availability of hair wings to prevent anxiety from
disturb body image.

After gastrostomy

Maintain nutritional status

• Administer parental nutrition

• Increase fluids according to the patient tolerance

• Stress the importance of long term vitamin B12 injections after gastrostomy to prevent surgically induced
pernicious anemia.

• Avoid high carbohydrate food , which trigger dumping syndrome and offer protein food.
Prevention dumping syndrome

• Eat five to six smaller meals throughout the day instead of three big meals.

• Avoid or limit sugary foods like soda, candy, and baked goods.

• Eat more protein from foods like chicken, fish, peanut butter, and tofu.

• Don’t drink fluids within 30 minutes before or after meals.

• Chew food completely before swallow to make it easier to digest

Prevention of phytobezoar formation

• Avoid fibrous food such as citrus fruits(skin and seeds)

• Stress the importance of chewing.

.
Prevention of pain
• Relieve massive burden of unnecessary suffering due to pain, other physical symptoms,
psychological ,social spiritual distress.
• Provide pain relief medicine according to protocol or WHO guideline. Morphine is
cornerstone of the management of cancer pain.

Prevention of anorexia
• Provide attractive food presentation.

• Provide good oral hygiene

• Provide antiemetic drug 30 min before meal to prevent nausea and vomiting.

• Provide rest when fatigue is experienced and reduce activity and mobilization
Prevention of stomatitis
• Apply antifungal and analgesic as prescribed.

• Provide oral hygiene using mouth wash, soft tooth brush or swab

• Avoid extreme hot and cold food as well as spicy food.

Prevention of infection
• provide neutropenia diet.

• Maintain hand washing, maintain respiratory hygiene using mask.

• Maintain environmental hygiene

• No more visitor allow in room

• Provide financial support as government rule.

• Provide spiritual wellbeing according to religion

• Provide cooking and stay place to care giver in institution palliation.

• Keep open communication with patient.

• Help patient accept his/ her own death.

• Offer practical suffer- help patient making will, help in solving quarrel, plan for
children custody

• Make sure that patient’s want is respected.

For family
• Share the sorrow- encourage them to talk and share the memory

• Ask if they can offered future school fee , help to find a solution if possible.

• Try to see if friend/ neighbor can offer practical help, cooking running errands can
help in midst of grieving

Palliative care is very important in gastric cancer to relieve symptoms,

maintain nutrition and improve quality of life from the time of diagnosis to
bereavement for the patient as well as family.