Palliative Care Practice for Lung Cancer Patient - Medication Management Review

Running head: Palliative care practice
Palliative care practice
Name of the student:
Name of the University:
Author’s note

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Initial diagnosis and brief explanation of the Patient condition
The pathogenesis of lung cancer along with other forms is commenced after the induction from
various habits like smoking which the patient was exposed to for a long time. The diseases
progression promoted the development of the multiple metastases in the patient (1). The patient
Tom was a chain smoker since sixteen years of age and that has rendered the development of
other associated pathogenesis like breathing troubles and susceptibility to pulmonary infection.
The patient complained breathing troubles along with chest pain. Lung cancer is known to be
facilitated by smoking cigarettes, which leads to severe disease manifestation. The diseases
manifestation occurs when the mutations in p53 gene which is a known tumor suppressor.
Smoking induces the pathogenesis by a phenomenon called “field effect” which affects the
epithelial tissues in the lungs and initiates cellular transformation (2). The continuation of
smoking induces the mutation process, which further alter the tissue structure and metastasis
generation in the surrounding tissues. This form of diseases progression takes about 20-25 years
to develop and since the onset of mutation. The risk of cancer exposure is initiated by the
smoking habits, which is enhanced by the effect of environment factors like pollutants. In case of
Tom, who is a construction worker received risk of exposure of environmental factors. The
condition of the patient was of centrally located tumor type. The patient showed signs of tumor
growth, which induced coughing, chest pain, atelectasis, post obstructive pneumonia. Tom also
showed sign wheezing breath and pericardial effusion. Diagnosis showed that the type of cancer
in Tom was of small cell lung carcinoma (SCLC) which is common for rigorous smokers (3). It
is centrally located where the tumor blocks the bifurcation of the airways. The origin of the
cancer was seen in the neuro-endocrine cells which produce neurotransmitters, growth factors
and vasoactive compounds which regulate the functionality of the lungs. Tom is detected to

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secrete ADH or ACTH. The growth of the tumor is very quick and the condition has spread to
various parts of his body. The CT scan report revealed that pathogenesis of his report. Low dose
x-ray scan showed abnormal mass index of the lung tissues in Tom. Lesions and other
abnormalities were detected which showed signs of carcinogenesis. Tom was diagnosed also on
the basis of sputum generation which showed abnormality. The main biopsy report showed that
Tom had stage II carcinoma (5). Tom also displayed symptoms of chest pain, asthma and
diabetes. The blood test revealed that Tom had 180mg/dl blood glucose level, which needed to
be controlled. Tom complained breathing trouble from time to time, which was diagnosed to be
asthma. The associated co morbidities made it more complicated to care for Tom.
Expected medications
The medication for Tom was provided by the practitioner to minimize his chest pain. Morphine
was selected the best choice for his condition which Tom was reluctant to take due to his lack of
knowledge and literacy. Tom was prescribed mitiglinide to treat his diabetes and for controlling
asthma, Formoterol was administered. Mitiglinide is the most preferred drug for treating type 2
diabetes as in case of Tom, it stimulates the by the blocking the channels and influx of calcium in
the cells (4). The excitation of the cell due to influx of calcium triggers the exocytosis of insulin
compounds. Formoterol is the beta 2 agonist, which causes dilation of bronchial cells and
provides passage off blood in the pulmonary compartments and induces the relaxation of smooth
myocytes such that the air is forced inside the lungs and the breathlessness is inhibited (6). The
severity of Tom’s cancer progression needed immediate chemotherapy to min size the growth of
the tumor. The biopsy report showed that Tom has stage IIa, meaning his tumor was 5cm in
diameter. The practitioner also prescribed targeted drug therapy for Tom, which included
administration of specialized drugs which bind to specialized receptors of the tumors and

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identify the tumor proteins and destroy their functionality. The therapy was associated with
chemotherapy, radiation therapy and interventional pulmonology from time to time. The
practitioner selected Crizotinib and Erlotinib, which is a known inhibitors of the kinase enzymes
in the cancer cells and help checking the cancer cell growth (7).
Summary of assumptions:
Medications usage during transition to palliative care and medications needed during progress
to end stage of disease:
At the end stage of lung cancer, the main issue for Mr. Tom is that he is having extensive
breathing problem and chronic pain. When palliative care is initiated, it is expected that patients
current medication regimen needs to be changed. Pain is a symptom that is seen in lung cancer
patient due to local effect of tumor or distant spread of tumor. Since Mr. Tom has been shifted to
end of life care because deteriorating symptom of pain, it is expected that palliative pain
management in initiated for Mr. Tom. Morphine is the first medication for pain management in
patients. However, this medication is associated with increase in symptom alleviation at end of
life (8). Hence, to provide high quality palliative care, it is expected that low dose of Opioid is
given to Mr. Tom. The use of opioids is considered effective for the management of advanced
lung cancer patient as it has no impact on their quality of life. The evidence also suggested that
opioid administration has no impact on survival rate of patient in acute care setting. The study
done regarding survival rate on opioid users in acute care setting suggested that there is no
significant difference in survival time of patient after mean daily dose of opioid (8). Hence,
opioid use is efficacious for Mr. Tom, only thing that needs to be considered by palliative care