This is a very common complaint and can adversely affect both appetite and mood. It is important to exclude infection, as this can often be treated. Ensure good and regular oral hygiene is being carried out. Dentures that do not fit may aggravate the problem. Dry mouth can also occur as a consequence of mouth breathing and as a long-term consequence of anti-cancer treatments.
Dry mouth is a common side-effect of many of the drugs used in palliative care, particularly the strong opioids and tricyclic antidepressants. If it is possible to stop or alter medication to diminish side effects without compromising other symptoms, this should be done.
Ensuring that the patient has regular small drinks may be sufficient to restore comfort. Simple measures such as chewing fresh pineapple, which stimulates the natural production of saliva and concurrently cleanses the mouth may be effective. Sucking boiled sweets or chewing sugar free gum can achieve adequate moistness in many cases.
Artificial saliva sprays, pastilles and tablets replace natural saliva and offer temporary relief. They may restore a patient’s ability to enjoy the taste of food. However their effect is often short lived and the patient may need to use the spray as frequently as every hour or so to get sustained relief.
A lack of energy and concentration leading to a sense of disinterest in the world and events around them is very common in patients with advanced disease.
Identifying and treating where appropriate reversible causes such as anaemia must be the first stage of management.
Ensuring patients have adequate amounts of good quality sleep may also help.
Providing aids to maximise function and minimise effort are a corner stone of management. There may need to be regular review to ensure the aids provided remain appropriate. Advice about conserving energy, carrying out tasks in stages and pacing activity may help.
Oral steroids (dexamethasone 4-6mg in a single daily dose) may temporarily increase a person’s sense of well-being, but may cause loss of muscle bulk in the long term. They are best restricted to a two week course.
Specialists may consider using low dose amphetamines if there are short-term goals to be achieved, but there are few helpful pharmaceutical interventions currently available.
