Rehabilitation in terminal cancer patients.

Abstract

Good terminal care may be described as rehabilitation of the dying, and is exemplified in the modern hospice. The aim is to help the individual patient to do his best, given his illness, his symptoms, and his cultural, familial and personal background and beliefs. Comfort is the primary objective, not prolongation of life. The patient and his family should be regarded as the unit of care. Sixty per cent of patients with far-advanced cancer experience pain. In the majority of patients it is not difficult to control pain provided certain basic principles are adhered to: 1. Careful evaluation of cause(s) of pain. 2. Realization that pain is a somatopsychic experience. 3. Use of an appropriate analgesic on a time-contingent basis. 4. Recognition that the effective dose of a narcotic analgesic varies widely. 5. Use of both non-drug and drug treatments. 6. Continuing surveillance of all patients, particularly those receiving a narcotic analgesic. A comparable analytical and systematic approach is necessary also in the management of other symptoms. Patients need professional friendship and support if they are to adjust to declining physical health and a poor prognosis. Gentle openness in matters of communication is fundamental; evasion and deceit are essentially destructive. Thed family too need much help if they and the patient are to become mutually supportive. Terminal care cannot be done by individuals, only by individuals working together as a team.