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Supportive care is a major component in the management of malignant diseases that affect the respiratory system. It should be included in the overall management plan for the patient from the very outset. Many patients who present with new respiratory or systemic symptoms of lung cancer will need urgent palliation of these problems, even before a definitive histological diagnosis can be made. Indeed, some patients who present late with advanced disease may be too ill for invasive diagnostic investigations, and palliative interventions will be planned on the basis of a working diagnosis of lung cancer, guided on radiological findings and clinical history. This chapter discusses the prevalence of symptoms in cancer, causes and assessment of symptoms in cancer, approaches to symptom management, technical advances in radiotherapy delivery, chemotherapy, comprehensive palliation of symptoms, and management of effusions.

Problems associated with pain and symptom management among children undergoing treatment for cancer is a major area of concern for clinicians. This chapter discusses methods of assessing and treating chemotherapy-induced nausea and vomiting, pain secondary to invasive procedures, and other distressing symptoms. It also reviews methods of evaluating individual differences among pediatric cancer patients in their vulnerability to pain symptoms, managing children's procedure-related pain and distress according to the needs of the individual child, and relationships between children's acute and chronic pain reactions. Focusing on acute pain, the chapter builds a framework for understanding variation in symptoms across children undergoing the same procedure or chemotherapy and variation in symptoms for the same child at different points in time. It also provides a brief review of the anatomy and physiology of pain transmission and inhibition.

This chapter discusses the management of non-pain symptoms in terminally ill patients. These symptoms include nausea and vomiting, constipation, bowel obstruction, dyspnea, and cachexia. The chapter explains the pathophysiology, principles of therapy and recommended treatment for each of these symptoms. It also suggests that palliative care should not be so much about what the practitioners do as about why they do it.

This chapter examines pain and symptom management for infants and children with a variety of life-limiting conditions. It explains that caring for infants and children with terminal illness is a complex challenge that requires a coordinated interdisciplinary effort across the continuum of care and that it is necessary for health professionals to work closely with the child and the family to meet this challenge. The chapter recommends a multimodal approach to treatment that includes integrating pharmacological and psychosocial care with intentional consideration of the child's physical, cognitive, emotional, and spiritual levels of development.

This chapter presents an overview of symptom management in palliative care. It explains that when considering symptom management of known, chronic illnesses, what is usually more important is to understand what clues the disease process can provide to understand and treat the symptoms of the patient. In the palliative setting, the relationship between the disease and the symptom is reversed; it is the disease process that becomes a clue to the symptom or patient experience.

The World Health Organization (WHO) defines palliative care as the active total care of patients whose disease is not responsive to curative treatment. Control of pain, other symptoms, and psychological, social, and spiritual problems is paramount. Multiple perspectives, obtained through a variety of research methods, are necessary to provide a greater understanding of the whole person. The goal of palliative care is to achieve the best quality of life for patients and their families. In pediatric palliative care, where systematic knowledge development is only in its infancy, such perspectives become even more critical. This chapter identifies extant research in pediatric palliative care and suggests additional methods or approaches for gaining multiple perspectives.

The guidelines presented in this book should give some insight into the advantages that result from an atmosphere of mutual cooperation. The discussion notes that managing the distress and the symptoms of advancing cancer, and being prepared to work alongside the primary team, may greatly reassure patients. Families and the professional are most likely to appreciate the extra dimension of supportive care that can be offered. This allows one to become part of a truly integrated service; offering a balanced approach to patients and families who are struggling to come to terms with the devastating impact of advanced cancer.

This chapter discusses the transition from palliative care in the hospital setting to terminal care in the home setting. After the decision to stop chemotherapy or aggressive treatment, families and patients often seek the comfort of their homes in the hopes of finding familiar surroundings. In instances such as this, rapid hospital discharge is a must; however, adequate support must be provided to avoid emergency situations. This chapter covers: how to determine if the patient and their families want a home-care setting; guidelines on creating good communication with the patients and the families, particularly on difficult issues; symptom management for patients with advanced haematological malignancies; how to plan a smooth and efficient hospital discharge; and how to determine risk factors associated with complicated bereavement.

Bedside teaching is quintessentially patient-centred. This chapter describes how bedside teaching can affect patients, learners, and teachers; introduces selected models of bedside teaching; and discusses how these models might be used in teaching palliative care. Palliative care is an ideal setting in which to teach and demonstrate whole patient care through bedside teaching. It is a useful mode of teaching for all aspects of palliative care, including symptom assessment and management, psychosocial and spiritual support, communication skills, ethical decision-making, and patient and carer involvement and education.