Nursing Care of End-Stage Nasopharyngeal Carcinoma Patients Receiving Palliative Care: a Case Study

Abstract

This study explored the palliative care of a patient with end-stage nasal cavity cancer treated at Sing Buri Hospital. The prominent symptom was significant bleeding from a chronic wound in the left neck mass, diagnosed as stage 4 nasal cavity cancer according to the Kadish staging system, indicating metastasis to distant organs. This represented the final stage of the disease, which was incurable, with most patients surviving less than one year. The study aimed to investigate the palliative care for patients with end-stage nasal cavity cancer, focusing on pain reduction, alleviation of other distressing symptoms, acceptance of the illness during its progression, and encouragement for patients to live with dignity and engage in desired activities.

The study involved a 51-year-old Thai male patient with a 20-year history of immunodeficiency. He was diagnosed with nasal cavity cancer.3 years before and treated with 7 sessions of radiotherapy before discontinuing treatment in favor of alternative herbal remedies. Upon hospital admission, the patient had a chronic, heavily bleeding wound on the left side of the neck. Initial emergency assessment showed an E4V5M6 status, significant bleeding from the neck wound, blood pressure at 93/57 mmHg, a pulse rate at 110 beats per minute, and a respiratory rate of 24 breaths per minute. The patient was diagnosed with end-stage nasal cavity cancer accompanied by shock and admitted for hospital care. He experienced a decline in consciousness and weakness, unable to consume food. Consultation with the palliative care team, the patient, and his relatives about advanced care planning allowed for informed decisions regarding end-of-life care preferences, explicitly opting out of intubation and resuscitative efforts.

To provide nursing care to patients with end-stage nasal cavity cancer under palliative management, nurses play a crucial role, so it is essential for them to have knowledge about disease pathology, treatment, and management of distressing symptoms. Offering holistic nursing care involves the participation of patients and their families in planning continuous care from the hospital to the home and community. This ensures that patients and their families maintain a good quality of life according to their illness condition, ultimately achieving the goal of palliative care for end-stage patients: a good death. The outcomes of this study can serve as a guideline for the care of other patients in the future.