"I Have a Terrible Sore Throat, I'm Itching and Haven't Slept in Days": Pharmacopalliation of Mucositis, Pruritus, and Insomnia in Hospice and Palliative Care Patients (SA514)

Abstract

•Describe the pathophysiology, clinical manifestations, and prevention of mucositis, pruritus, and insomnia.•Identify pharmacologic and non-pharmacologic interventions for mucositis, pruritus, and insomnia.•Summarize the scientific evidence underlying the successful management of mucositis, pruritus, and insomnia. Symptom assessment tools are designed for the clinician to quickly and effectively determine the presence and severity of the most common symptoms encountered in palliative care or hospice patients. Mucositis, pruritus, and insomnia are all assessed in the Memorial Symptom Assessment Scale but could be missed by using a tool such as the Edmonton Symptom Assessment Scale (ESAS). The purpose of this session is to raise the awareness of these less common but equally distressing symptoms that can pose a challenge to successful management in many patients. Mucositis refers to mucosal damage within the gastrointestinal tract. It occurs in 20–40% of patients receiving conventional chemotherapy and up to 80% of patients receiving high-dose chemotherapy preparation for stem cell transplantation and nearly all patients receiving chemotherapy and radiation therapy for head and neck cancer. Additionally, certain oral-targeted therapies for cancer produce a significant amount of morbidity from this adverse effect. Pruritus is a nuisance symptom, but many patients suffer from protracted episodes of suffering as a result of poorly executed therapy by clinicians. Opioid therapy for an underlying pain condition often produces pruritus. However, it may be an adverse effect of other medications as well as experienced by patients with end-stage hepatic or renal disease. Insomnia is often overlooked in the overall symptom burden of many patients in hospice and palliative care. Clinicians must exercise great care when using sleep aids in combination with opioids due to the enhanced risk of opioid-induced respiratory depression. Insomnia is the most common risk factor for the subsequent development of delirium, especially in the hospitalized patient. Restoration of sleep hygiene is essential to the overall care of the palliative care and hospice patient. At the completion of this concurrent session, participants will be prepared to utilize the latest evidence-based information to palliate the symptoms discussed.