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Cancer patient at home: pain, vomiting, breathlessness

A cancer patient at home does not mean "nothing can be done" — it means a different task: not to cure, but to remove pain, nausea and breathlessness. Palliative services, home hospice teams and, in acute situations, an ambulance crew licensed to carry strong opioids all exist for this.

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What to do right now

Pain is treated in steps
Step one: paracetamol and ibuprofen. Step two: tramadol. Step three: morphine and fentanyl. Enduring pain is neither noble nor useful — the longer it is endured, the harder it is to control.
Opioid prescriptions
Issued free by the oncologist or the local GP; no certificate of incurability is required. A fentanyl patch lasts three days and avoids injections.
Nausea and vomiting
Anti-emetics as prescribed, small frequent sips; for persistent vomiting, a drip.
Breathlessness
Semi-sitting position, an open window, an oxygen concentrator if saturation falls; low-dose morphine relieves the sensation of breathlessness — as prescribed.
Palliative care is free
A home hospice team, pain control and training for the family — by referral from the oncologist or GP. In Moscow this goes through the Centre for Palliative Care.

Call an ambulance if

Pain not controlled by the prescribed drugs for more than 2–3 hours
Vomiting for more than a day, inability to drink or take tablets
Breathlessness at rest, saturation below 90 %
Bleeding from the tumour, blood in vomit or stool
Confusion, seizures, inability to wake the patient
Urinary retention, or no bowel movement for 4–5 days with abdominal pain

What not to do

Do not endure pain "to avoid addiction" — dependence does not develop in cancer pain treated properly
Do not give oral drugs during vomiting — use injections or a patch
Do not call the state ambulance for every pain episode if a palliative plan exists — they will come but cannot write prescriptions
Do not leave the patient alone with breathlessness or confusion

What the crew does

Examination, pain assessment, oxygen saturation, blood pressure
Pain relief including strong opioids — AYUMED holds a licence for narcotic and psychotropic drugs
Anti-emetics, infusion, oxygen, catheterisation, enema
Transport to hospital, to a hospice, or home from hospital with escort

This page is for information and does not replace a medical examination. If the condition worsens, call the crew: +7 (985) 887-82-52.

This page in Russian: Russian version.

Questions

Can you come and give a strong opioid injection?

Yes: AYUMED holds a licence for the circulation of narcotic and psychotropic substances of lists II and III, so the crew may provide such pain relief on a call. This is emergency help, not a substitute for prescriptions — continuous pain control is arranged by the clinic or palliative service.

How much does a visit to a cancer patient cost in Moscow?

Call-out 6,000 ₽ inside the MKAD; procedures by the price list, including strong analgesics, injections and infusions. Transport to a hospice or home from hospital is charged by the transport tariff.

How do we get into a hospice?

By referral from the oncologist or GP to the Moscow Centre for Palliative Care; the home team visits, and inpatient hospice care is for uncontrolled symptoms. We transport patients to hospices with escort.