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Due date – 5/04/2021
Word count – 1500 equivalent
Reference style – Harvard style (15 -20 references)
As part of writing the essay, you will need to review the biomedical literature and provide a bibliography in the Harvard style. Answer the case study part A and B.
a) Map the treatments that were administered over the course of her illness (from the time of diagnosis to her death) including mechanism of actions of the drugs used for cancer therapy, pain and psychological issues.
b) Describe other technologies that might be used to detect colorectal cancer before it becomes malignant.
Case Study
Cancer treatment and management Nellie was a 63 year old patient who died in hospice care. She battled colon cancer for 4 years but it was only detected at stage IVA when a number of lesions had also appeared in her liver. The only reason she went to the doctor in the first place was because she had noticed a lot of blood in the toilet bowl after a bowel motion. The doctor immediately referred her for a colonoscopy, which detected a number of polyps in the colon and these were surgically removed. The ensuing MRI revealed a number of spots on the liver. Over the next 4 years, she had several rounds of chemotherapy, starting with 5-fluorouracil, then irinotecan and finally oxaliplatin. During annual follow-up colonoscopies, there was never any sign of recurrence of the cancer in her colon. The cancer in the liver had shrunk initially and then re-grown with each new chemotherapy drug. Routine blood tests were conducted with each cycle of chemotherapy. She had to deal with various side-effects including hair loss, and periods of intermittent diarrhoea and constipation, hypokalaemia, neutropenia and fatigue. With the support of her husband Ron and two adult daughters who live in the same city, she was able to cope with the changes to her physical appearance and gradual deterioration in her sense of well-being.
She was relatively stable until 2 months ago when she experienced severe back pain after falling awkwardly while playing tennis with her husband Ron and she became unable to walk. An X-ray confirmed that the cancer had spread to her spine (stage IVB) and was compressing the spinal cord. Targeted radiotherapy at a major cancer hospital failed to shrink the tumour. Nellie was transferred to hospice care and pain management medication was initiated.
Nellie’s pain was carefully monitored and she received 4g of paracetamol per day as well as subcutaneous morphine. She developed oral dysphagia and could not swallow oral medications or fluid and she felt nauseous. Oral medications ceased and feeding and hydration was exclusively via an intravenous tube. She appeared agitated and made frequent requests for extra medication for breakthrough pain, even though she reported feeling no pain. Staff reassured her and psychological counselling was also initiated. She experienced bouts of anger that her family could not be with her 24 hours per day and guilt because she felt that she was a burden on them. Her family became more and more upset and concerned about her changing moods. They asked if something could be done to ‘help her calm down’. The family was reassured that this was a phase Nellie’s terminal illness that would progress to gradual acceptance with lots of love and support. Nellie did become more peaceful in her relationship with her family, and found great solace in writing them all letters to read after she had passed on about her love for them and how she would live on through them. However, as renewed pain from her spinal tumour continued to increase, she became agitated, nauseous and emotional and the dose of morphine was difficult to titrate against the pain.
Following a family meeting in consultation with her medical team, she was commenced an end-of-life pathway with levomepromazine and sublingual clonazepam. She became more and more drowsy and unresponsive and died after 9 days. Her husband and children had been called in urgently the night before she died and they were grateful that they were with her when she passed away.


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