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Education in Palliative and End-of-life Care - Oncology

The. EPEC-O. TM. Education in Palliative and End-of-life Care - Oncology. Project. The EPEC-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

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Education in Palliative and End-of-life Care - Oncology

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  1. The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

  2. EPEC – Oncology Education in Palliative and End-of-life Care – Oncology Module 3q Symptoms – Skin

  3. Skin wounds . . . • Acute vs. chronic; likely to heal or not • Chemotherapy agent extravasation • Radiation damage • Decubitus ulcers • Malignant wounds

  4. . . . Skin wounds Associated with • Pain • Depression • Anxiety • Poorer interpersonal interactions

  5. Key points • Pathophysiology • Assessment • Management

  6. Skin symptoms • Organ system • Highly innervated • Visible • Psychological, social, and spiritual • Interdisciplinary care • Symptom control

  7. Chemotherapyextravasation: pathophysiology • Acute wound • Products of inflammation • Redness • Swelling • Pain • Cell death • Necrosis, open wound

  8. Radiation: pathophysiology • Radiation damage • Acute wound • Products of inflammation • Cell death

  9. Decubitus ulcers: pathophysiology • Pathophysiology • Ischemia • Fat is protective

  10. Malignant wounds: pathophysiology • Disrupted physiology • Products of inflammation • Neovascularization • Bleeding • Necrosis • Anaerobic and fungal infections

  11. Assessment . . . • Acute versus chronic • By wound type

  12. Chemotherapy extravasation: assessment • Type of chemotherapy • Vesicant, eg, doxorubicin • Irritant, eg, carmustine • Non-irritants, eg, fluorouracil • Extent • Volume of extravasation and time • Seconds, minutes, hours • Involved anatomy

  13. Radiation: assessment • Radiation sensitizers • Topical agents • Drugs, including chemotherapy • Dose and fractionation schedule • Expected course

  14. Decubitus ulcers • Assessment • Risk factors • Prevention • Skin protection – shear / tear / moisture • Pressure reduction and pressure relief

  15. Decubitus ulcers: staging • Non-blanchable erythema • Partial-thickness skin loss • Full-thickness skin loss • Extensive necrosis exposing muscle or bone

  16. Management • Acute versus chronic • By wound type

  17. Necrotic wound: management • Debridement • Surgical • Enzymes and gels • Mechanical • Pain control • Cleansing

  18. Chemotherapy extravasation: management • Contain damage • Stop infusion • Neutralize • Assess for surgical consultation • Watch and wait

  19. Radiation: management • Promote healing • Avoid cytotoxic agents • Moist environment • Treat infection • Pain control

  20. Decubitus ulcers: management • Goals: healing vs non-healing • Healing • Debridement • Dressings that promote healing • Non-healing • Pain control, comfort • Prevent worsening

  21. Decubitus ulcers: dressing • Moist, interactive environment • Control infection • 6 types of dressing • Foams • Alginates • Hydrogels • Hydrocolloids • Thin films • Cotton gauze

  22. Malignant wounds: management • Healing vs non-healing • Infections • Odors • Pain • Exudate • Bleeding

  23. Odors • Topical and / or systemic antibiotics • Metronidazole • Silver sulfadiazine • Kitty litter • Activated charcoal • Vinegar • Burning candles

  24. Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience

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