- When cancer and Pain are mentioned together that usually triggers a very bleak perception. While this might be true for cancer patients approaching end of life yet with advances in surgery and oncology, nowadays we see a lot of cancer survivors that might be struggling with chronic pain conditions secondary to their treatment be it surgery causing chronic post-surgical pain and/or chemotherapy and radiotherapy causing neuropathic pain. Please refer to neuropathic pain for more information about this category of cancer related chronic pain conditions.
- The other category are those patients approaching end of life. At that stage, management follows a palliative approach. Honesty and clarity with patients and their families/ carers is very important but as important is adopting a holistic and sensitive approach using multidisciplinary expertise that involves cooperation between oncology in case there is room for any palliative radiotherapy or chemotherapy, oncology psychology to support patients and families psychologically, palliative care and Pain medicine.
- Patients’ wishes are of utmost importance and should be explored early and followed. Spiritual support is important depending on patients’ belief system.
- At that stage, patients would have been introduced to hospice as a setup available to support patients in case their symptoms are difficult to control at home.
- Management of pain depends on use of medications including Morphine medications but also interventions such as injections to ease symptoms and stop doses of Morphine from going out of control. Some of those interventions could be offered in hospice based on using neurolytic agents to ablate specific nerves but other interventions need specialised centres such as performance of percutaneous cordotomy for unilateral cancer or insertion of intrathecal drug delivery systems to control symptoms.
- The ultimate goal of the care of terminal cancer pain patients is offering them a dignified peaceful end while supporting their families and carers through challenging moments.
- Dr Alkholany built an excellent experience in managing this group of patients through his role as an honorary consultant in cancer pain management at one of the community-based hospices in Liverpool, working collaboratively with palliative care as well as oncology colleagues.