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Management of Terminal Hemorrhage in Patients With Advanced Cancer: A Systematic Literature Review
Journal of Pain and Symptom Management, 10/16/09

Harris DG et al. – From 3,564 initial citations, 18 were appropriate to include in the final review, many of which focused on patients with head and neck tumors. The reported incidence of significant bleeding in patients with advanced cancer is 6%–14% and incidence of terminal hemorrhage 3%–12%. Key areas arising from the literature were 1) identifying patients at risk, 2) general supportive measures to use, and 3) use of sedative medication. General supportive measures included use of dark towels to camouflage blood loss, use of suction, and applying external pressure. There was variation in the recommended sedative medication (drug, dose, and route). Drugs recommended included diazepam, midazolam, diamorphine, and ketamine at varying doses and routes of administration. Current guidelines are based completely on isolated case reports and expert opinion. Clinical research is needed in this area but is difficult because of practical and ethical limitations.

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