OCC OCC Supportive Care & Symptom Management 1 — Questions and Answers
Question 1: A patient with advanced cancer rates their pain as 7/10 and is currently on scheduled oral morphine. Which WHO analgesic ladder principle guides the next step?
- Add a non-opioid adjuvant and remove the opioid
- Increase the opioid dose or switch to a stronger opioid for uncontrolled moderate-to-severe pain (Correct answer)
- Switch to non-pharmacologic methods only
- Reduce the opioid dose to prevent tolerance
Correct answer: Increase the opioid dose or switch to a stronger opioid for uncontrolled moderate-to-severe pain
The WHO analgesic ladder recommends stepping up to stronger opioids or increasing the current opioid dose when moderate-to-severe pain (≥7/10) is not controlled by the current regimen.
Question 2: Which nutritional screening tool is MOST commonly recommended for oncology patients to identify malnutrition risk?
- Body Mass Index (BMI) measurement alone
- Patient-Generated Subjective Global Assessment (PG-SGA) (Correct answer)
- 24-hour dietary recall only
- Serum albumin level
Correct answer: Patient-Generated Subjective Global Assessment (PG-SGA)
The PG-SGA is the oncology-specific nutrition screening tool validated for cancer patients, assessing weight loss, food intake, symptoms, functional capacity, and physical exam findings.
Question 3: A terminally ill cancer patient reports existential distress and loss of meaning. Which supportive care approach is MOST appropriate?
- Refer exclusively to psychiatry for pharmacological management
- Initiate dignity therapy or meaning-centered counseling with palliative care support (Correct answer)
- Increase opioid doses to reduce psychological discomfort
- Reassure the patient that these feelings will resolve after treatment
Correct answer: Initiate dignity therapy or meaning-centered counseling with palliative care support
Dignity therapy and meaning-centered counseling are evidence-based psychotherapeutic interventions specifically designed to address existential distress in terminally ill patients.
Question 4: Which integrative therapy has BEST evidence for reducing chemotherapy-related nausea and vomiting as a complement to antiemetics?
- Aromatherapy with peppermint oil
- Acupuncture and acupressure (Correct answer)
- Magnet therapy
- Herbal supplements including ginger capsules at high doses
Correct answer: Acupuncture and acupressure
Acupuncture and acupressure (particularly at the P6/Neiguan point) have the strongest evidence base among integrative therapies for reducing chemotherapy-induced nausea.
Question 5: A patient on long-term opioid therapy for cancer pain develops opioid-induced constipation unresponsive to stimulant laxatives. What is the MOST appropriate next intervention?
- Discontinue the opioid and switch to NSAIDs
- Administer methylnaltrexone (Relistor) to reverse peripheral opioid effects in the GI tract (Correct answer)
- Increase dietary fiber intake to 30g/day
- Administer a saline enema daily
Correct answer: Administer methylnaltrexone (Relistor) to reverse peripheral opioid effects in the GI tract
Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist that reverses opioid-induced constipation without crossing the blood-brain barrier to reverse analgesia.
Question 6: A patient with advanced cancer is transitioning to hospice care. What is the PRIMARY goal of hospice care?
- Achieve remission using aggressive chemotherapy
- Maximize comfort, dignity, and quality of life while supporting the patient and family (Correct answer)
- Prolong survival at all costs with curative intent
- Provide wound care and medication management only
Correct answer: Maximize comfort, dignity, and quality of life while supporting the patient and family
Hospice care's primary goal is comfort-focused care that maximizes quality of life, manages symptoms, and supports the patient and family through the dying process.
OCC OCC Supportive Care & Symptom Management 1
A patient with advanced cancer rates their pain as 7/10 and is currently on scheduled oral morphine.
Which WHO analgesic ladder principle guides the next step?