Management of Infections in Palliative and Terminal Cancer Care

Česká verzia

Authors: M. Sochor
Authors place of work: Komplexní onkologické centrum, KN Liberec a. s.
Published in the journal: Klin Onkol 2013; 26(5): 323-330
Category: Review

Summary

Background:
Patients with cancer are highly susceptible to infections. There is a lack of evidence‑based guidelines or protocols for their management in palliative and end‑of‑life care.

Purpose:
To define an optimal diagnostic approach and therapeutic management of infections in patients with palliative and terminal cancer care. Along with thromboembolic disease and cancer progression, infections are the most frequent causes of death in oncology. Besides the impact on mortality, they are accompanied with a myriad of symptoms decreasing the quality of life. High incidence of infectons is due to a malignancy itself, the oncolgical therapy and host factors. There is a lack of evidence‑based guidelines and protocols for the therapy of infections in palliative and terminal cancer care. Most of available studies are retrospective in nature, with diverse methods and cohorts. Incidence of infections in these patient oscillates between 16– 55% in specialized palliative units, and rises up to 83% in acute care hospitals. From the epidemiologic viewpoint, urinary (39– 42%) and respiratory infections (22– 36%) are the most frequent cases, followed by soft tissue and skin infections (6– 12%) and bacteremias (5– 14%). At present, the antibiotic treatment does not seem to have a positive impact on the survival rate. Symptom control antibiotic therapy as a means of symptom control still remains controversial, since it meets this purpose only in a few percents of studies. The most successful is the symtom control in urinary tract infections (60– 79%), in contrast to other sites of infection (30– 43%). In the last week of life there the symptom control is achieved only in 10% of patient. One should always consider the prognosis, actual preformance status and patient‘s preferences when it comes to the management of diagnostics and therapy of infections. If the prognosis counts in weeks or months the diagnostics and therapy should not differ from the approach to any other oncological patient. In terminal cancer care the antibiotics should be spared strictly for the purpose of symptom control and with a palliative intent. This article reviews current knowledge of diagnostics and therapy of infections in palliative cancer care and includes an algorithm for their management.

Key words:
palliative care – supportive care – terminally ill cancer – infection – diagnosis and therapy – blood cultures – antibiotics – fever

The author declare he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Submitted:
28. 4. 2013

Accepted:
26. 5. 2013

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