A DIAGNOSIS OF CANCER can elicit a wide range of concerns and anxieties in patients, including the fear of experiencing significant pain at some point in the disease process or its treatment. However, while it’s not uncommon for cancer patients to experience pain, and in some cases it can be severe, this symptom is by no means a foregone conclusion. With today’s advanced therapies, cancer pain can usually be managed effectively, allowing patients to enjoy the highest possible quality of life. The key is for cancer patients to communicate openly with their medical care team about any pain they have so prompt, appropriate steps can be taken to control it.
According to Alicia Wohlfarth, CNP, of The Toledo Clinic Cancer Centers, cancer-related pain can be either acute or chronic and there are many different factors that can cause or contribute to pain of varying degrees in cancer patients. For example, as tumors enlarge, they can press against surrounding tissues or organs, causing pain. Cancers that tend to metastasize to the bones, such as lung, breast, or prostate cancer, commonly cause severe bone pain. Pancreatic cancer, among others, increases the risk of developing deep vein thrombosis, which can cause pain and swelling in the affected area, usually the legs.
Pain can also stem from the various therapies used to treat cancer. “One major side effect of treatment is mucositis, or inflammation of the mucosal membrane, which can cause painful ulcerations in the mouth and throat. This is seen with some forms of chemotherapy as well as with radiation for head and neck cancer. Another potential side effect of certain chemotherapy drugs is peripheral neuropathy, which can cause an unpleasant ‘pins-and-needles’ or burning sensation in the hands and feet,” Wohlfarth says.
Of course, these examples merely scratch the surface of factors that can cause pain in cancer patients. Furthermore, every patient is different with respect to how he or she experiences and describes pain. Since each patient’s pain experience is unique, treatment must be tailored to the individual, taking into account the type and stage of the cancer, the area of the body involved, the patient’s age, current medications taken, any co-morbidities the patient may have, therapies that have benefited the patient in the past, any history of medication abuse, as well as other factors.
Wohlfarth notes that the degree to which patients’ pain is controlled has a tremendous impact on their perception of how well their cancer is being managed overall. In addition, if pain intensifies or recurs, patients often make the assumption that their cancer has progressed. “Uncontrolled pain leads to unnecessary discomfort, the reduced ability to perform activities of daily living, and the potential for repeated hospitalizations, which can disrupt their cancer treatment regimen. Patients who have poorly managed pain also tend to have a more grim outlook and are less likely to find purpose in continuing in their fight against the disease,” she says.
Treatment for mild to moderate cancer-related pain typically begins with the use of non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen. Moderate to moderately severe pain may respond well to a drug such as Percocet, which is a combination of the opioid oxycodone and acetaminophen. Depending on how often pain relief is needed and how well the patient is responding to treatment and doing with activities of daily living, the treatment team has the option of altering dosages or trying different, longer-acting medications.
Numerous other forms of treatment can be figured into the pain-relief equation as well. For instance, with certain cancers, chemotherapy can help ease pain by reducing the size of tumors, and radiation is sometimes used to treat bone pain at the site of a known lesion. For patients with pain due to lymphedema (the swelling of extremities that often occurs when lymph nodes are surgically removed as part of cancer treatment), it can be highly beneficial to enroll them in a lymphedema clinic where the proper use of compression garments and other techniques to reduce swelling are taught. Again, these are just a few of many examples. “For patients with chronic pain, there is also the option of being seen in our pain management specialty group, whose sole purpose is to control pain using the very latest therapies and technologies,” Wohlfarth adds.
For patients with metastatic cancer, pain management is provided as part of the comprehensive palliative-care program The Toledo Clinic Cancer Centers offers in partnership with Sincera – Supportive Care and Symptom Relief. Wohlfarth explains that participating in this program does not mean the patient is in end-of-life hospice care. Rather, the purpose of palliative care is to manage symptoms as well as address the emotional, psychological, and spiritual factors of their pain so they can have the best possible quality of life.
Wohlfarth also encourages patients to participate in support groups offered by community organizations such as The Victory Center and Cancer Connection of Northwest Ohio, as well as to keep an open mind about alternative treatments such as massage, Reiki, healing touch, reflexology, and other services that promote healing and reduce stress.
At The Toledo Clinic Cancer Centers, the dialogue about pain is ongoing. “At every appointment, we ask patients if they are having pain and, if so, what they’re doing to alleviate it. That conversation is very important. If patients are completely honest about what they’re feeling and the medications they are taking, it allows us to manage their pain more effectively,” says Wohlfarth.
The Toledo Clinic Cancer Centers, located at 4126 N. Holland Sylvania Road, Suite 105, also provides imaging, laboratory, chemotherapy, specialized pharmacy, and IV services. The cancer center consists of 8 medical and 3 radiation oncologists along with 11 nurse practitioners and 4 research nurses. The cancer center also has satellite centers in Maumee, Napoleon, Bowling Green, Wauseon, and Monroe.
The Toledo Clinic Cancer Centers has earned Patient-Centered Specialty Practice recognition and Oncology Medical Home recognition from the National Committee for Quality Assurance. Oncology homes align systems and resources with coordinated care focused on cancer patients and their needs. This reduces fragmentation, supports shared decision making, and improves the patient experience. They are the first oncology practice in the state of Michigan and the second oncology practice in the state of Ohio to receive this recognition.
For more information, please call The Toledo Clinic Cancer Centers at 419-479-5605. ✲
