1626936841469_Case Presentation- Afthab Kassim.pptx

Case presentation palliative

1. Name of Case Presenter : AFTHAB KASSIM Designation : NHM MEDICAL OFFICER Organizational Affiliation : PHC VANNAPURAM CASE PRESENTATION

2. PATIENT DETAILS Age: 69 Gender: FEMALE DIAGNOSIS: CA HYPOPHARYNX –POST CRICOID AND UPPER OESOPHAGUS

3. PRESENTING COMPLAINTS Headache -1 week P ain in neck region-1 week D ecreased sleep-1 week

4. HISTORY OF ILLNESS k/c/o Carcinoma hypopharynx diagnosed on May 2020,underwent chemoRT,total laryngopharyngectomy+gastric pull up+feeding jejunostomy on June 9 2020. W as advised another cycle of radiation therapy after the surgery,but was not willing. One year after surgery,ie,from first week of June 2021 started experiencing headache and pain neck. Pain scale 7/10,not relieved by NSAIDS Pain throughout the day,unable to sleep because of pain. S een lying over her bed all day in room.

5. EXAMINATION V itals –WNL Resp,CVS-WNL CNS-WNL

6. TREATMENT AND SIGNIFICANT INVESTIGATION Consulted local ENT doctor-advised MRI to r/o brain metastasis. No imaging studies done. Inj Dexona trial done. Referred to palliative physician.

7. PSYCHOSOCIAL ASPECTS G ood family support. Has KASP insurance to cover medical expenses. P atient had a very positive attitude for doing surgery,but was not willing to undergo RT after surgery. After surgery,for one year patient was happily living having her favourite foods through mouth,playing with grandchildren and watching her favourite TV show. Since the onset of headache ,ie,from first week of June 2021,appearing gloomy and withdrawn.

8. MEDICATIONS Oral morphine 0.5 mg 5 times daily(bedtime 1 m g). Laxatives,anti emetics,MVT. After starting medication,symptoms improved. P atient now feels happy .

9. MAIN CONCERN Brain metastasis

10. SUMMARY 69 year old female who is a k/c/o Ca hypopharynx,post chemoRT,post surgery,developed headache and pain in neck region one year after surgery. Consulted local physician who advised MRI Brain,but patient was not willing. Referred to palliative physician who started oral morphine . Patient symptomatically better after starting morphine.

11. DISCUSSION POINTS (Points to be discussed in class based on the patient’s story) Should the patient had been compelled to undergo radiation therapy after the surgery so that the recurrence may have been avoided? Is imaging study necessary at this stage? Wa s it right on the part of local physician to refer the patient to palliative physician? Now the patient is as happy as before. Do you think the family members have taken right decision at every stage of the treatment?

12. Respect patient autonomy after explaining and informing the implications of not undergoing treatment. She might be knowing better about her own life. Our duty is to discuss in detail about the treatment. We have to agree with the patient’s decision after all. Imaging or any other investigation is to be recommended, if it is going to make a major change in the treatment plan. If RT is still the option that you have after brain MRI, then probably it may not work It was absolutely right decision to refer to Palliative care physician. PC should go hand in hand with disease modifying treatment. And sometimes PC teams might be able to communicate and convince the patient to undergo disease modifying treatment If the patient is happy, then you have taken the right decision. But we need to prepare the patient and family for progression of illness, especially when you anticipate worsening of symptoms

13. THANK YOU AFTHAB KASSIM NHM MO,PHC VANNAPURAM.