Palliative Care and Pain Management for the Cancer Patient

Written by  Amir Tabatabai, MD
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Cancer patients may suffer from various symptoms such as pain, shortness of breath, nausea, vomiting, fatigue, anxiety and depression. These symptoms can be caused either by the cancer itself or by chemotherapy and radiation therapy offered by oncologists.

pain-managementPalliative care is the relief of pain and suffering. It is part of the oath of Hippocrates and an inseparable part of the discipline of oncology.  Even though oncologists have provided palliation as part of their daily routine for decades, it hasn’t been until the last few years that palliative care has gained formal recognition and has become subject of vigorous academic study. National guidelines have been developed, and clinical trials designed at further improvement of symptoms have become common place. I would like to highlight a few recent findings.

healthcare-pillsNeuropathic pain is common in patients who receive chemotherapy. It is a sharp pins-and-needles sensation in finger or toe tips. It does not respond well to traditional pain medicines such as narcotics or anti-inflammatories such as ibuprofen. At our recent American Society of Clinical Oncology (ASCO) Annual Meeting it was reported in a large randomized placebo-controlled trial that an antidepressant called duloxetine significantly benefited patients with this type of pain, improving their quality of life. This was an important find.

In another study at ASCO this year researchers showed that olanzapine was significantly superior to metoclopramide in preventing chemotherapy induced nausea and vomiting. Over 70% of patients who took olanzapine 10 mg once daily for only 3 days after chemotherapy had no nausea or vomiting.

healthcare-reform-scanA futuristic area of research is using genetic markers to predict who is more likely to experience side effects of therapy. Those patients can then get more optimal supportive care minimizing side effects of chemotherapy.

At the York Cancer Center we have been enrolling patients who undergo radiation therapy in a trial studying the potential protective effect of Manuka honey in preventing radiation burn and pain. Patients who participate in such clinical trials will allow development of more effective palliative care measures for future generations.

Amir Tabatabai, MD
Cancer Care Associates of York

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