As a young medical student more than 20 years ago, cancer is a disease that fascinates me. Cancer was becoming an important health condition in the developed world. A diagnosis of cancer has high impact upon the patient, the family and the society. The complexity of the disease garnered a lot of interest. Cancer research was a huge thing and billions of dollars was spent in a race to cure this disease. Treatment of cancer involve not only the patients and the control of their symptoms, but also helping both the patients and their family understand the disease and continue to live an active and fulfilling life.
In the past, cancer and cancer pain management were difficult with limited treatment options. It was difficult to administer treatment, considering that knowledge and technology was not as advanced as today. Now, the availability of cancer directed drugs has increased many folds, with hundreds of types readily available. All these have led to effective control of this disease and their complications including pain. There are even specifically designed medications to control different types of pain, as well as nausea and other side effects that arise from treating cancer. Management of cancer has improved so much that about 85 per cent of cancer patients now get outpatient treatment. This allows the patient to take control of their daily lives, stay out of the hospital, travel and maintain a relatively normal life.
Pain in cancer is multi-faceted. To control physical pain, Panadol and related light weight pain killers will usually be the first line medication prescribed to a cancer patient with mild pain symptoms. Aspirin like medications, known collectively as Non-Steroidal Anti-inflammatory drugs are used for persisting or increasing pain. Codeine and Oxycodone will be added to Panadol to battle moderate pain. Stronger drugs like Morphine and Fentanyl are the later line of medication for a cancer patient to use if the pain is very severe. Sometimes, pain can be neuropathic, associated with injury to the nerves relating neural impulses to the spinal cord and brain. Some of this will recover with removal of the insulting agents; others may require neuropathic pain medications.
Control of the tumour is important in the control of pain symptoms in cancer patients. This frequently includes chemotherapeutic treatments to achieve disease control. In the case that the drugs are insufficient, a surgical procedure may be considered to control or eliminate the pain. Surgeons may burn away ganglion, which are a mass of nerve cell bodies, so that pain signals won’t be relayed to the higher cognition centres initiating the undesired sensation of pain. Radiation may also be effective in purging localized regions of pain derived from cancerous tumours.
Besides physical pain, cancer patients face emotionally pain, and this needs a lot of attention. Understanding patient’s perspectives, anxieties and fears is an important aspect in the management of emotional strife. It is also important to address the concern of the patient’s family and care givers. Understanding the disease, prognosis and treatment plan will aid in the treatment of the patient both emotionally and physically. For instance, understanding the good prognosis of some early stage cancer will not only relieve anxiety and stress present in the patient and their care givers, but also help encourage compliance to the treatment plan. For those who have advanced stage disease, doctors can still optimize treatments to relieve any pain or discomfort, providing patient with the best possible quality of life. It is possible for many patients with advanced cancer to continue an active and close to normal lifestyle. Nothing gives more clinical satisfaction than seeing patients planning for their next vacation trip or family get together.
For more information, visit Novena Cancer Centre, #09-41, 38 Irrawaddy Road. Singapore 329563. Tel: 6339 0233.
