General issues

• Palliative care - general issues (CKS)

​Constipation

• Palliative care - constipation (CKS)

Cough

• An intractable cough may be relieved by moist inhalations or by regular administration of oral morphine. Methadone linctus should be avoided because it has a long duration of action and tends to accumulate.

• Palliative care - cough (CKS)

Dyspnoea

• Palliative care - dyspnoea (CKS)

Malignant skin ulcer

• Palliative care - malignant skin ulcer (CKS)

Nausea and vomiting

• Palliative care - nausea and vomiting (CKS)

Oral/mouth care

• Palliative care - oral (CKS)

Pain

• When commencing treatment with a strong opioid for a patient with advanced and progressive disease, patients should be offered oral morphine (either immediate-release or sustained-release) with a typical starting dose of 20–30 mg per day. The quoted doses of immediate-release morphine and oxycodone are too high for a starting dose – especially considering that this patient is opioid naïve. Patients should not be offered transdermal patches as first-line if oral medication is suitable.

• Palliative care - pain (CKS) / Palliative care for adults: strong opioids for pain relief (NICE, 2016)

• Also see: hypercalcaemia

Pruritus

• Chlorphenamine. Even when associated with obstructive jaundice, pruritus may respond to simple emollients or topical antipruritics. A trial of an antihistamine can also be considered. If pruritus persists, seek advice; specialist options include SSRIs (cholestatic pruritus) and gabapentinoids (uraemic pruritus)

Secretions

• Glycopyrronium. Excessive respiratory secretions may be reduced by hyoscine. Alternatively, glycopyrronium may be given by subcutaneous or intramuscular injection. Care is required to avoid the side effect of a dry mouth.

• Palliative care - secretions (CKS)

Spinal cord compression

• Metastatic spinal cord compression in adults: risk assessment, diagnosis and management (NICE, 2008)​

Miscellaneous 

• One chance to get it right: how health and care organisations should care for people in the last days of their life (Leadership Alliance for the Care of Dying People, 2014), Sorting things out - information and support (Macmillan), How do people die from cancer? (Guardian, 2016)