PACE Case: Cancer Pain Control

A newly enrolled PACE participant came onto service with Stage 4 metastatic breast cancer, which had metastasized to the liver, bone, lungs, and lymph nodes. Upon enrollment, she had extensive pain, for which she was taking Dilaudid 2mg every 6 hours, and nausea (possibly narcotic related).

CK INTERVENTION:
Convert Dilaudid dose to an equivalent MS Contin dose of 15mg every 12 hours (First checked renal function to discern whether MS Contin or OxyContin would be appropriate.)The CK clinical pharmacist consulted with PACE, recommending that the following be considered to help the comfort of this end-of-life participant:

  • Add a short-acting opioid (MSIR 15mg every 3-4 hours PRN), since her pain had not been adequately relieved
  • Add Zofran ODT 8mg every 4 hours PRN for the nausea

The clinical pharmacist also extensively counseled on the benefit of adding dexamethasone (4-8mg daily—could be split to twice-daily dosing) to:

  • increase appetite
  • help with her bone pain (for which she currently receives palliative radiation)
  • help with her breathing (she has COPD as well)
  • reduce inflammation in the capsule surrounding her liver
  • reduce the swelling in her lymph nodes

RESULT:
All recommendations have been accepted and therapy has been initiated. Our goal is adequate pain relief in an effort to maximize this participant’s quality of life as she enters the final stages of her courageous battle.

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