Palliative care in cancer — formative SAQs

SAQ 1 (10)

An eight-year-old girl with relapsed medulloblastoma is admitted with a severe pain flare, her parents exhausted after months of treatment and frightened by her deterioration. The oncology team is weighing another line of disease-directed therapy against the burden it will bring. ^{[2] [4]}

a) Give the World Health Organization consensus definition of palliative care, and explain why the integrated concurrent model that runs the palliative care alongside the disease-directed therapy is preferred to the sequential model that defers it to moment curative treatment fails. (3 marks) ^[1][2]

b) Outline the structured symptom assessment you would perform across the four dimensions of suffering, naming the validated tools you would use and the place of the family's proxy report. (3 marks) ^[4][2]

c) The child's pain is uncontrolled. State the principles of the World Health Organization analgesic ladder, how you would calculate the breakthrough opioid dose from the background, and the circumstances and the method for an opioid rotation. (2 marks) ^[3]

d) Outline the goals-of-care and advance care planning conversation you would hold with the family at this turning point, and the documents that would carry the plan. (2 marks) ^[2][6]