Cancer Pain Managementin Palliative Care Patients

Hale Duran Tan, RN, Hülya Kafalı, RN

Pain and Palliative Care Clinic

Ankara Oncology Education and Teaching Hospital, Ankara, TURKEY

The Pain and Palliative Care Clinic at Ankara Oncology Hospital was organized in July 2007. We have eighteen patient beds in our clinic. After evaluating the patients at Pain Policlinic and Nutrition Policlinic, they are admitted to service for further treatment. Our team includes 5 experienced anesthesiologists, 2 anesthesiology residents, 9 nurses, dietitiant, social workers, psychologist and physical therapist.

The mission of the service is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Palliative care is appropriate at any stage of an illness, regardless of prognosis, and it can be delivered alongside curative treatments. Palliative care can be integrated with medical care intended to cure disease, and is not intended to be used only when a patient has terminal disease. In fact, more patients each year are cancer survivors, but many cancer survivors suffer from chronic pain as a result of the surgery, radiation, or chemotherapy necessary to cure their cancer. These patients also can benefit from palliative care. We have one of the largest cancer rehabilitation program in Turkey, with medical experts in medical oncology, radiation oncology, anesthesiology, physical medicine, psychology, psychiatry, and other disciplines as needed working together to assess and manage severe cancer-related symptoms. Our clinic also provides consultation servicesto other clinics to adjustthetreatment plans of inpatients that experience pain related to their underlying disease.

Between January 2007 and December 2008, 671 patients were admitted to the Pain and Palliative Care Clinic. A total of 671 patients attended the Pain and Palliative Clinic, of which only 43 patients had non-cancer diseases. Of the 628 cases, gastrointestinal system cancer incidence was 47%, genitoürinary system cancer 14%, lung cancer 14%, head and neck cancer 10%, breast cancer 7%, other cancers 8%. 272 patients suffered from a terminal event. Pain was the most common symptom at admisssion. 99% of the patients presented with pain.

In our service optimum pain control is achieved by:

  • formulatingan individualized treatment plan specific toeach patient's needs
  • using a combination of pain management strategies such as non-pharmacologic methods, pharmacotherapy, nerve blocks, implants and other procedural pain management techniques (e.g RF techniques, neurolytic blocks )
  • practicingwith a continuum of care approach beginning with a comprehensive assessment
  • utilizing frequent reassessment to adjust treatment planswhen necessarybased on disease progression, side effects and/or other factors
  • assessing each patientthrough a multidisciplinary approach involving professionals from various disciplines, including psychiatry and neurosurgery.

As oncology nurses, we actively involve all patients, as well as their family caregivers in the development of a pain and palliative management plan of care and encourage open communication for the reporting of pain at all times.