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Refractory pruritus from malignant cholestasis: management
  1. GVMC Fernando1,2 and
  2. Nancy Preston3
  1. 1 National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
  2. 2 Department of Family Medicine, University of Sri Jayewardenepura Faculty of Medical Sciences, Nugegoda, Sri Lanka
  3. 3 International Observatory of End of Life Care, Lancaster University, Lancaster, UK
  1. Correspondence to Dr GVMC Fernando, National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Nugegoda 10100, Sri Lanka; chemetf{at}


This case report deals with a patient managed in a tertiary-care cancer hospital who suffered pruritus associated with malignant cholestasis. His symptoms were resistant to conventional treatment with ursodeoxycholic acid, chlorpheniramine and cholestyramine. Hence, the multifactorial origin of malignancy-associated pruritus was considered. Correctable factors were corrected and generally the treatment was aimed at possible aetiologies. There were barriers related to insufficient resources available for symptom palliation in this particular setting, which could potentially reduce optimum symptom control. However, various pharmacotherapies and non-pharmacological measures which could potentially have helped relieve pruritus are described and future scope for research in this area discussed.

  • cancer
  • jaundice
  • gastrointestinal (upper)
  • pruritis
  • hospital care

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  • Twitter @chemetf, @nancypreston16

  • Contributors GF involved himself with the clinical care of the patient, which subsequently led to a discussion with NP. NP guided GF’s clinical management in the role of a supervisor. The case report prepared by GF was scrutinised by NP while making additions and modifications. Further, the final overall version submitted for publication is guaranteed for by GF.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.