Foreword

There is far too much unnecessary suffering experienced by cancer patients at every stage of their condition, from the moment of diagnosis to either cure or death. There is ample evidence for this, and yet, despite the means now available to control pain and suffering, these means are not always adequately employed by the oncologists, medical or surgical specialists, or general practitioners involved in the management cancer patients.

Why is it that in 2015 the suffering of cancer patients is still so prevalent in hospitals, in institutions and in their homes? Why are all doctors and nurses not adequately trained in the scientific methods of relieving pain and symptoms, the art of communicating with their patients and the importance, scientifically as well as good doctoring, of dealing with their emotions?

The answer to these questions lies in the history of Palliative Medicine. Only 60 to 70 years ago doctors had little ability to cure disease. No sophisticated diagnostic aids, no antibiotics and very little in the way of curative measures.

They practised the “Art of Medicine”. Their main function was to alleviate symptoms as best they could and to give comfort to the patient and the family. There was often less suffering among dying patients as laudanum was available in those days, the administering of which was all that could be done.

Then in the 1960s came the explosion in the science and technology of medicine; the ability to cure beyond all previous expectations and the heady experience of actually being able to artificially prolong life. But, what is often not realised is that this often means prolonging suffering or even causing it.

The excitement of these dramatic advances in medicine gave birth to a new era, with its own problems. The thrust of teaching, especially in the Western world, shifted towards a disease-focused approach in which the patient as an individual is largely forgotten. Medical schools started to produce scientists, at the expense of teaching patient-centered “good medicine”.

In 1998 I founded The Palliative Medicine Institute to teach doctors and nurses an Expanded Approach to Palliative Care, meaning that “the skills and ethos of palliative care should be available for any patient, with any illness or condition, at any stage, from the moment of first contact with the patient for the duration of the illness or condition” and not only for those with life-threatening or terminal illnesses.

Then, in 2000 at the request of the then Professor of Medicine, we started the Hospital Palliative Care Team. This has been operating in the CMJAH for 14 years, receiving referrals, not only from the Oncology and HIV/AIDS wards, but from diverse disciplines. In addition to teaching and ensuring the implementation of appropriate pain management protocols, the Team is of indispensable value to overworked and understaffed medical staff, who rarely have sufficient time to listen and communicate adequately with the patients. The documented results and benefits are undisputable. Not only do the patients benefit in hospital, but they frequently are discharged earlier consequent to relief from their physical and emotional suffering. Shorter hospital stays are cost beneficial, so the hospital administration benefits too.

This guide is an important tool, which can assist any medical practitioner, not only those treating patients with cancer, to manage patients optimally. The message it holds is that this is not difficult to achieve if all doctors and nurses learned the skills and ethos taught in palliative medicine.

This is a guide for doctors who might say to patients, “I’m so sorry, but there is nothing more that I can do.” It demonstrates that there is always something that one can do. It is a guide for doctors who do not know that they do not know the comprehensive approach that is necessary for optimum patient care, and have never been taught the important skills and ethos of relief of suffering – not only to the cancer patient, but to every patient.

The management of chronic pain is not a “one-person job”. It is far too complex, with too many disciplines that may need to be involved to be managed by only one physician, surgeon or oncologist. Bringing the nurse dealing with the patient into the management team is not practised often enough. She/he should be asked to report on the needs of the patient, whether the pain and/or symptom relief is adequate, and any psychosocial or emotional problems that need referral. When the nurses are given that task, it relieves the doctors and makes the nurses feel that their work is important.

So it is clear that there is no “one size fits all”. Care must be individualised and comprehensive, and that demands a team approach. The ideal composition of the appropriate team is well described in the guide.

In conclusion, I would like to say that I feel honored to have been asked to write the foreword to this important document. This excellent guide to cancer pain and suffering is long overdue. It gives me, personally, great hope that at last, after 25 years, the struggle I have experienced to integrate the ethos and principles of palliative care into the main stream of medicine – in other words, patient-centered medicine – is being taken up by younger dedicated and knowledgeable professionals. I believe that if properly used, this guide will make an enormous difference not only to the patient experience, but also to the doctors and nurses involved in patient management.

I encourage readers to approach what follows with an open and curious mind. The words that I have found most important in my long career are these: “I don’t know, but I will do my best to find out”.

Professor Selma Browde;
MBBCh, MMed RadT