End-of-Life Choice, Palliative Care and Counseling

palliative care

The Hospice Option

By Susan Canfora
The Daily Times
September 15, 2012

Talking about death is difficult.

Even for an oncologist, telling a patient treatment isn’t working, they most likely aren’t going to be cured and it’s time to think about a different kind of care is grueling.

“It’s a very hard conversation to have,” said Dr. David Cowall, medical director of Coastal Hospice in Salisbury, shaking his head and recalling spending a minute alone in his office to gather his thoughts before having that talk with patients.

“If we’re not going to cure them, there comes a time to stop treatments and look at comfort and care. Some patients bite your head off when you tell them that. Some tell you off and some go somewhere else,” Cowall said.

Interested in determining if patients are better off continuing traditional medical care or going into hospice, where symptoms are managed, Cowall co-authored the paper “End-of-Life Care at a Community Cancer Center.” It was published in the June 2012 issue of the Journal of Oncology Practice. More

Poor Pain Control for Cancer Patients

By Pauline W. Chen, MD
The New York Times
September 20, 2012

Recounting her father’s struggle with cancer was difficult for the young woman, even several years after his death. He’d endured first surgery and then chemotherapy and radiation, she told me, and the cancer had gone into remission. He was thrilled, but the aggressive treatment left him with chronic, debilitating pain. Once active, he struggled to get around in his own home.

“It wasn’t the cancer that got him,” the daughter said. “It was the pain.”

Her father had turned to all of his doctors, with little relief. His surgeon had looked at his operative wounds, pronounced them well healed, then stated that they were in no way responsible for his disability. Both his cancer doctor and his radiation doctor congratulated him on being in remission but then declined to prescribe pain medications since they were no longer treating him and couldn’t provide ongoing follow-up and dosing guidance. His primary care doctor listened intently to his descriptions of his limitations, but then prescribed only small amounts of pain meds that offered fleeting relief at best.

“I’ll never forget what my father had to go through,” she said, weeping. “I wouldn’t wish this on anyone.”

I wish I could have reassured her that her father’s case was unusual. Sadly, according to a new study in The Journal of Clinical Oncology, a significant percentage of cancer patients continue to suffer from pain as her father did. More