Palliative care for oral cancer

Abstract

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness. For pain assessment, it is important to obtain not only the onset, duration, location, quality, pattern, character, and intensity of pain but also aggravating and relieving factors, associated symptoms and signs, and current pain management agents and their effectiveness. To treat cancer pain, this principles can be summarized in five steps (by the mouth, by the clock, by the ladder, for the individual, and attention to detail). The use of opioids should not be affected by unfounded fears such as respiratory depression, tolerance, or dependence. When satisfactory alleviation of cancer pain cannot be achieved as a result of regular assessment of the response to analgesics or therapy, opioid- resistant cancer pain should be assessed. Opioid- resistant cancer pain includes underdosing, poor absorption or intake of opioids, raised intracranial pressure, and neuropathic pain. In cases of neuropathic pain, adjuvant analgesics such as anticonvulsants or antidepressants should be considered. Both prevention and appropriate interventions for opioid-related adverse effects such as constipation, nausea and vomiting, and drowsiness are one of the key components to continue to treat cancer pain.