Pain and Symptom Management for Cancer Patients

Transcript

00:00 --> 00:03Funding for Yale Cancer Answers is
00:03 --> 00:06provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:11Yale Cancer Answers features the
00:11 --> 00:13latest information on cancer
00:13 --> 00:15care by welcoming oncologists and
00:15 --> 00:17specialists who are in the forefront
00:17 --> 00:19of the battle to fight cancer.
00:19 --> 00:21This week, it's a conversation about
00:21 --> 00:23palliative care with Doctor Andrew Putnam.
00:23 --> 00:25Doctor Putnam is an assistant
00:25 --> 00:26professor of clinical medicine
00:26 --> 00:28at the Yale School of Medicine,
00:28 --> 00:31where Doctor Chagpar is a
00:31 --> 00:34professor of surgical oncology.
00:34 --> 00:35Andrew, maybe we can start off by
00:35 --> 00:37you telling us a little bit more
00:37 --> 00:39about yourself and what it is you do.
00:40 --> 00:42I went to medical school thinking I
00:42 --> 00:46wanted to be a small town doctor
00:46 --> 00:48and went to residency and found out
00:48 --> 00:50that I like talking to patients
00:50 --> 00:52too much to be able to do that
00:52 --> 00:54because you you're not allowed
00:54 --> 00:57a lot of time for family doctors.
00:57 --> 01:00So I found this new specialty
01:00 --> 01:03called palliative care
01:03 --> 01:06and have been doing that ever since.
01:06 --> 01:08So I'm a palliative care physician at Yale,
01:08 --> 01:12and we do pain and symptom management.
01:12 --> 01:16We do goals of care conversations.
01:16 --> 01:19We help other physicians take
01:19 --> 01:21care of their patients.
01:21 --> 01:23We're an extra layer of support.
01:24 --> 01:26So we've had people
01:26 --> 01:28on that show and we've talked
01:28 --> 01:30previously about palliative care.
01:30 --> 01:33But for those who may be unaware,
01:33 --> 01:36tell us a little bit more about what
01:36 --> 01:38exactly palliative care is because it
01:38 --> 01:40seems to me that there is sometimes
01:40 --> 01:43some confusion around the term.
01:43 --> 01:45Some people think it means pain and
01:45 --> 01:47symptom management, some people
01:47 --> 01:51think it means end of life Hospice care.
01:51 --> 01:53Can you tell us a bit more about what
01:53 --> 01:54your definition of palliative care is?
01:55 --> 01:58I'd be glad to, thank you.
01:58 --> 02:01I guess part of the the confusion stems
02:01 --> 02:04from actually the official
02:04 --> 02:07title of my medical specialty is Hospice
02:07 --> 02:09and palliative medicine put together.
02:10 --> 02:13So the way I think about it is
02:13 --> 02:16Hospice is part of palliative medicine,
02:16 --> 02:18but a small part. So some of the
02:18 --> 02:21patients I see are end of life,
02:21 --> 02:24but some of the patients I see are very
02:24 --> 02:27early in their disease trajectory.
02:27 --> 02:30I got called a couple of weeks ago by an
02:30 --> 02:32oncologist saying I've got this patient
02:32 --> 02:36who I'd like to treat with chemotherapy,
02:36 --> 02:38however, his pain is so bad
02:38 --> 02:40that he's in bed all the time.
02:40 --> 02:41Can you, Doctor Putnam,
02:41 --> 02:44please come and help me get his pain under
02:44 --> 02:48control so that I can treat this patient?
02:48 --> 02:52And there's a fair bit of that where we
02:52 --> 02:55treat the the symptoms caused by the disease,
02:55 --> 02:57we treat the symptoms
02:57 --> 03:00caused by the treatments.
03:00 --> 03:04But it is confusing.
03:04 --> 03:06A few weeks ago I walked into a
03:06 --> 03:08patient's room in the hospital,
03:08 --> 03:10said I'm from palliative care
03:10 --> 03:11and the patient started to cry thinking it was end of life.
03:17 --> 03:21In my practice probably about
03:21 --> 03:2520% is Hospice and 80% or so are people
03:25 --> 03:28much earlier in their disease and
03:28 --> 03:30I'm trying to help them get treated.
03:31 --> 03:34But I think part of the issue
03:34 --> 03:36is that there are many people who do
03:36 --> 03:39parts and parcels of the same thing.
03:39 --> 03:41So for example, the story that
03:41 --> 03:43you told earlier about
03:43 --> 03:45treating a patient who has pain so that
03:46 --> 03:47you could get the pain under control so
03:47 --> 03:50that he could be treated with chemotherapy.
03:50 --> 03:52Some people would think that that
03:52 --> 03:56patient should have been referred to a
03:56 --> 03:58pain service or an anesthesia service.
03:58 --> 04:01Can you tell us about the overlap
04:01 --> 04:03that exists between palliative care
04:03 --> 04:06and a number of other specialties?
04:07 --> 04:11That's a great question.
04:11 --> 04:15So palliative medicine,
04:15 --> 04:16I'm part of a Cancer Center.
04:17 --> 04:19So if a patient has cancer,
04:19 --> 04:21the oncologist treats the cancer and
04:21 --> 04:24some of the things the oncologist does
04:24 --> 04:27may make the patient not feel so great,
04:27 --> 04:29losing their hair, nausea.
04:29 --> 04:31People hear about this,
04:31 --> 04:32but they're treating the cancer.
04:34 --> 04:36Palliative medicine is the other
04:36 --> 04:38side of the coin, I guess.
04:38 --> 04:41I don't do anything about the cancer.
04:41 --> 04:43My job is just to make
04:43 --> 04:44the patient feel better.
04:44 --> 04:47And whether that's pain and
04:47 --> 04:48symptom management discussions,
04:48 --> 04:52we do a lot of talking with patients
04:52 --> 04:55about how to approach their disease.
04:55 --> 04:58We give a lot of support.
04:58 --> 05:00If a patient has pain,
05:00 --> 05:02if they go to anesthesia,
05:03 --> 05:05if they can treat the pain,
05:05 --> 05:08they'll usually use needles or some
05:08 --> 05:10nerve block, something like that,
05:10 --> 05:12which I don't do.
05:12 --> 05:15So sometimes we do send people
05:15 --> 05:17who have specific needs to them,
05:17 --> 05:20but for pain service,
05:20 --> 05:21palliative medicine,
05:21 --> 05:24one big part of our job is to take the
05:24 --> 05:27patient and take all the different parts,
05:27 --> 05:29the cancer, the lungs, the heart,
05:29 --> 05:31all the different parts that may be treated
05:31 --> 05:34and put it together to make the person,
05:34 --> 05:36and we treat the person.
05:36 --> 05:38My team and I,
05:38 --> 05:40our job is to help the patient
05:40 --> 05:43get through what's going on.
05:43 --> 05:45So pain is one thing that we do,
05:45 --> 05:46but it's only part.
05:47 --> 05:50So tell us more about the other parts.
05:50 --> 05:52I mean, you mentioned you and your
05:52 --> 05:54team and I think that's one of the
05:54 --> 05:56big things about palliative care is
05:56 --> 05:58that it is this multidisciplinary
05:58 --> 06:00team that has many different parts.
06:00 --> 06:03Can you talk a little bit more about that?
06:03 --> 06:05I'd be glad to. Thank you.
06:05 --> 06:10So in much of medicine,
06:10 --> 06:13it's usually the Doctor at the
06:13 --> 06:15top and everyone else,
06:15 --> 06:19their job is to support the doctor.
06:19 --> 06:21In palliative medicine, it's very different.
06:21 --> 06:24The basic unit of palliative care
06:24 --> 06:27is a doctor, a nurse,
06:27 --> 06:29a social worker, and a chaplain.
06:29 --> 06:32And to be a true palliative care group,
06:32 --> 06:35all four of those need to be present.
06:35 --> 06:37And the reason is that we
06:37 --> 06:38all approach the person,
06:38 --> 06:41the patient, in different ways,
06:41 --> 06:44we have different training and we focus on
06:44 --> 06:46different aspects of the patient's suffering.
06:46 --> 06:47So for example,
06:47 --> 06:51I guess about a year ago palliative medicine,
06:51 --> 06:52palliative care,
06:52 --> 06:54got consulted to a patient and
06:54 --> 06:56when I went to talk with him,
06:56 --> 06:59his biggest problem was the
06:59 --> 07:01suffering he was going through
07:01 --> 07:04of why is God doing this to me?
07:04 --> 07:06And that was, as I said,
07:06 --> 07:07the main point of his suffering.
07:07 --> 07:10And I can talk to him a little
07:10 --> 07:11bit about that,
07:11 --> 07:14but I very quickly got my chaplain involved
07:14 --> 07:16because this was a type of suffering,
07:16 --> 07:19and my chaplain is much better trained to
07:19 --> 07:22treat that kind of suffering than I am.
07:22 --> 07:25Same with a social worker and nurse.
07:25 --> 07:26Their training is different,
07:26 --> 07:29they come at the person in a different
07:29 --> 07:31way and often they are able to
07:31 --> 07:34do things that I am not able to
07:34 --> 07:35because my training is different.
07:35 --> 07:37In addition, on our team,
07:37 --> 07:39we have a psychologist,
07:39 --> 07:40we have a pharmacist,
07:40 --> 07:42we have an art therapist.
07:42 --> 07:46We try and treat the patient's total
07:46 --> 07:49suffering in as many different ways as
07:49 --> 07:52is necessary and being part of Yale,
07:52 --> 07:54we also have nutritionists,
07:54 --> 07:56integrative medicine specialists,
07:56 --> 07:58and there are others who we can call,
07:58 --> 08:00as you asked earlier about,
08:00 --> 08:02like anesthesia pain if those
08:02 --> 08:04specialties would be helpful.
08:05 --> 08:08And so it sounds like this is really,
08:08 --> 08:10quite remarkable, right,
08:10 --> 08:14because regardless of what the patient's
08:14 --> 08:17suffering comes from, whether it's a
08:17 --> 08:20spiritual existential crisis,
08:20 --> 08:24whether it is financial toxicity,
08:24 --> 08:26whether it is pain,
08:26 --> 08:30whether it is psychological distress,
08:30 --> 08:32there's somebody on your team
08:32 --> 08:35who is able to help that patient
08:35 --> 08:38and the load doesn't fall on the
08:38 --> 08:40treating physician and similarly the
08:40 --> 08:43load doesn't fall on the patient.
08:43 --> 08:45So that sounds like that's
08:45 --> 08:46just an incredible resource.
08:46 --> 08:48But as you say,
08:48 --> 08:51this is something that you have at
08:51 --> 08:53a large academic center like Yale.
08:53 --> 08:57What do you do if you're in the
08:57 --> 08:59community and maybe you are
09:00 --> 09:03a cancer patient who may be suffering
09:03 --> 09:06and you want to access palliative care,
09:06 --> 09:08how do you do that?
09:10 --> 09:12Also a good question.
09:12 --> 09:14So we are a relatively new specialty
09:14 --> 09:18in that we've only been a recognized
09:18 --> 09:20specialty since about 2007.
09:20 --> 09:24And so many physicians and nurses
09:24 --> 09:27still don't know what we do.
09:27 --> 09:29It's getting less common,
09:29 --> 09:31but it still happens where it's suggested
09:31 --> 09:34to send a patient for a palliative
09:34 --> 09:36care consult and the response is,
09:36 --> 09:38oh no, it's much too early, the
09:38 --> 09:41patient isn't dying.
09:41 --> 09:44So the best way to get us involved
09:44 --> 09:47though is for the patient to ask the
09:47 --> 09:50doctor, whether it's a cardiologist
09:50 --> 09:53or their lung doctor or an oncologist.
09:53 --> 09:55Any of these certainly can have
09:55 --> 09:58access to help from palliative care,
09:58 --> 10:00especially as an inpatient
10:00 --> 10:02when they're in the hospital.
10:02 --> 10:05So asking for it,
10:05 --> 10:08the hope is that the doctor will
10:08 --> 10:09understand that it's appropriate.
10:11 --> 10:13And they will call us,
10:13 --> 10:15but patients often need to
10:15 --> 10:18ask doctors more and more are
10:18 --> 10:20thinking about us as a helpful
10:20 --> 10:23extra layer of support for them.
10:23 --> 10:26But it still is
10:26 --> 10:28helpful if the patient asks,
10:29 --> 10:31is palliative care available
10:31 --> 10:33on an outpatient basis?
10:33 --> 10:34I mean, it sounds wonderful
10:34 --> 10:36when you're in the hospital,
10:36 --> 10:38but for many oncology
10:38 --> 10:40patients they are
10:40 --> 10:41at one point or another let
10:41 --> 10:43out of the hospital.
10:43 --> 10:44And for them,
10:44 --> 10:46I can imagine that part of it
10:46 --> 10:47gets even more burdensome because
10:47 --> 10:50now they may feel like they are
10:50 --> 10:52all alone having to deal with
10:52 --> 10:56this with their family at home.
10:56 --> 10:59Are there resources for outpatient
10:59 --> 11:00palliative care?
11:00 --> 11:05Yes, there certainly are for cancer patients.
11:05 --> 11:09We have a clinic in Smilow in New Haven,
11:09 --> 11:12but also in North Haven and
11:12 --> 11:14other Smilow oncology clinics
11:14 --> 11:17around this part of the state.
11:17 --> 11:20And so we can have regular meetings
11:20 --> 11:22with patients and they can avail
11:22 --> 11:24themselves of telephone calls
11:24 --> 11:27to us if they're home and their
11:27 --> 11:29pain is worse and they need help.
11:29 --> 11:30And quickly,
11:30 --> 11:32and if people aren't at Yale
11:32 --> 11:34and they're in the community,
11:34 --> 11:36can they do the same kind of thing?
11:36 --> 11:39Talk to their doctor and see if there's
11:39 --> 11:41outpatient palliative care that they
11:41 --> 11:43might be able to avail themselves of?
11:44 --> 11:47Yes, definitely ask the oncologist
11:47 --> 11:51because many of the sites now have
11:51 --> 11:54palliative care available at that site.
11:54 --> 11:56And if not, maybe they can see a
11:56 --> 11:59physician at a different site.
12:00 --> 12:02You know, one of the
12:02 --> 12:03questions that comes up is
12:03 --> 12:05it sounds like such a
12:05 --> 12:06tremendous resource, right?
12:06 --> 12:08You've got integrative oncology,
12:08 --> 12:10you've got art therapy,
12:10 --> 12:14you've got all of these people.
12:14 --> 12:16Some people might be looking at this saying,
12:16 --> 12:18wow, that sounds like such a
12:18 --> 12:20tremendous resource and certainly
12:20 --> 12:22an extra layer of support.
12:22 --> 12:25But it's not free and at a time
12:25 --> 12:27when people are facing really
12:27 --> 12:31expensive therapies and the financial
12:31 --> 12:33toxicity associated with that,
12:33 --> 12:34one may wonder,
12:34 --> 12:37is palliative care covered by insurance?
12:38 --> 12:39Great question.
12:39 --> 12:41Yes, insurance covers us.
12:41 --> 12:45We are paid basically the same
12:45 --> 12:47way that the oncologist is.
12:47 --> 12:51I don't know of any insurance, NOTE Confidence: 0.786141265
12:51 --> 12:53there may be some, but I don't know
12:53 --> 12:56of any insurance that is paying the
12:56 --> 12:59oncologist different from palliative care.
12:59 --> 13:03There usually is some sort of
13:03 --> 13:06payment at the beginning, but
13:08 --> 13:10insurance does pay for us.
13:11 --> 13:12Fantastic. Well,
13:12 --> 13:14we're going to take a short
13:14 --> 13:16break for a medical minute.
13:16 --> 13:18And on the other side,
13:18 --> 13:19we'll learn more about palliative
13:19 --> 13:20care with my guest,
13:20 --> 13:22Doctor Andrew Putnam.
13:22 --> 13:24Funding for Yale Cancer Answers
13:24 --> 13:26comes from Smilow Cancer Hospital,
13:26 --> 13:28where their one-of-a-kind.
13:28 --> 13:29Sexuality, intimacy,
13:29 --> 13:31and menopause program combines medical
13:31 --> 13:33and psychological interventions
13:33 --> 13:35for women who experience sexual
13:35 --> 13:37dysfunction after cancer.
13:37 --> 13:40Smilowcancerhospital.org.
13:40 --> 13:42There are many obstacles to
13:42 --> 13:43face when quitting smoking,
13:43 --> 13:46as smoking involves the potent drug nicotine.
13:46 --> 13:48Quitting smoking is a very
13:48 --> 13:49important lifestyle change,
13:49 --> 13:51especially for patients
13:51 --> 13:52undergoing cancer treatment,
13:52 --> 13:55as it's been shown to positively
13:55 --> 13:56impact response to treatments,
13:56 --> 13:58decrease the likelihood that patients
13:58 --> 14:00will develop second malignancies,
14:00 --> 14:02and increase rates of survival.
14:02 --> 14:04Tobacco treatment programs are currently
14:04 --> 14:06being offered at federally designated
14:07 --> 14:08Comprehensive cancer centers such
14:08 --> 14:10as Yale Cancer Center and Smilow
14:10 --> 14:11Cancer Hospital.
14:11 --> 14:13All treatment components are
14:13 --> 14:16evidence based and patients are
14:16 --> 14:17treated with FDA approved first
14:17 --> 14:20line medications as well as
14:20 --> 14:22smoking cessation counseling that
14:22 --> 14:24stresses appropriate coping skills.
14:24 --> 14:26More information is available
14:26 --> 14:27at yalecancercenter.org.
14:27 --> 14:30You're listening to Connecticut public radio.
14:31 --> 14:33Welcome back to Yale Cancer Answers.
14:33 --> 14:35This is doctor Anees Chagpar
14:35 --> 14:37and I'm joined tonight by my guest,
14:37 --> 14:38Doctor Andrew Putnam.
14:38 --> 14:41We're talking about palliative care and pain
14:41 --> 14:44and symptom management for cancer patients.
14:44 --> 14:46And while we talked a lot prior
14:46 --> 14:48to the break about how palliative
14:48 --> 14:50care is really an extra layer
14:50 --> 14:52of support for cancer patients,
14:52 --> 14:54the next question I have for you,
14:54 --> 14:57Andrew, is what about the caregivers?
14:57 --> 14:59What about the family?
14:59 --> 15:01Because so often they carry
15:01 --> 15:04quite a bit of the load.
15:04 --> 15:06Can you talk a little bit about
15:06 --> 15:08the support that you can offer them?
15:10 --> 15:11Great question.
15:11 --> 15:17Family is so crucial to a patient's care.
15:17 --> 15:19I think oncologists,
15:19 --> 15:20palliative care doctors,
15:20 --> 15:23certainly we want a caregiver to come
15:23 --> 15:27with the patient to their meetings
15:27 --> 15:29with their doctors when possible.
15:29 --> 15:31They are what I call
15:31 --> 15:33the external brain.
15:33 --> 15:34They're the person who's
15:34 --> 15:36there to remember things,
15:36 --> 15:37to write things down.
15:37 --> 15:39And this is very important because
15:39 --> 15:42patients often have a tough time
15:42 --> 15:44remembering everything that's
15:44 --> 15:46going on given the medications
15:46 --> 15:48they're given and given the
15:48 --> 15:50amount of information that
15:50 --> 15:53patients are given also at home,
15:53 --> 15:56they're crucial to the care at home.
15:56 --> 15:58I tell caregivers that
15:58 --> 16:01if you don't rest,
16:01 --> 16:03if you don't take care of yourself,
16:03 --> 16:05then you're not going to be able
16:05 --> 16:07to do the best job you can taking
16:07 --> 16:09care of your loved one and
16:09 --> 16:11so their care is going to suffer.
16:11 --> 16:14So sadly many caregivers feel that they
16:14 --> 16:18have to be there all the time, 24/7.
16:20 --> 16:24They need self-care as well.
16:24 --> 16:27It's also important for the patient
16:27 --> 16:29to understand how important the
16:29 --> 16:32caregiver is and also how much
16:32 --> 16:34suffering they're going through.
16:34 --> 16:36It's very clear that a patient
16:36 --> 16:38and we know we can see this,
16:38 --> 16:39a patient is suffering when
16:39 --> 16:41they have the disease,
16:41 --> 16:42when they get treatment and how
16:42 --> 16:44much suffering they go through.
16:44 --> 16:47But what's really important for
16:47 --> 16:49the patient and the medical
16:49 --> 16:52team to understand is that the
16:52 --> 16:54caregiver is also suffering.
16:54 --> 16:57The example I use when I talk to
16:57 --> 16:59patients and caregivers is you know
16:59 --> 17:02in the old movies
17:02 --> 17:04when they capture the professor
17:04 --> 17:06who has the secret formula?
17:06 --> 17:08They usually don't torture him,
17:08 --> 17:10they torture his family,
17:10 --> 17:11his kids, his wife.
17:11 --> 17:15Because watching someone you love suffer
17:15 --> 17:18is in many ways more difficult
17:18 --> 17:20than suffering yourself.
17:20 --> 17:22So we support the family,
17:22 --> 17:26we have groups to help family members,
17:26 --> 17:28we have groups for patients as well.
17:30 --> 17:33I can't say enough about how
17:33 --> 17:34important the caregiver and the
17:34 --> 17:37family is in the care of a patient.
17:41 --> 17:45I think that goes hand in hand with why
17:45 --> 17:48caregivers often suffer burnout because
17:48 --> 17:52they know that the patient can see
17:52 --> 17:54that they are suffering and they
17:54 --> 17:56don't want to appear as though they're
17:56 --> 17:59suffering because they know that that
17:59 --> 18:01will exacerbate the patient suffering.
18:01 --> 18:03And the patient's already suffering with
18:03 --> 18:05cancer, so they don't want to make it worse.
18:05 --> 18:09And so the caregiver tends to take
18:09 --> 18:12on more to show that, you know what,
18:12 --> 18:14this is. OK, I've got it.
18:14 --> 18:16When in fact, you know,
18:16 --> 18:18they they may need a bit
18:18 --> 18:19of self-care themselves.
18:20 --> 18:22Yes, caregiver burnout is
18:22 --> 18:26such an important topic and one
18:26 --> 18:29that is not thought about very much.
18:29 --> 18:32But yes, the caregiver needs self-care.
18:32 --> 18:36They need some time to be able to go out and
18:36 --> 18:39do something for themselves to take their
18:39 --> 18:43mind off what's going on when possible.
18:43 --> 18:47Patients and caregivers,
18:47 --> 18:49both of them have
18:49 --> 18:52thoughts about things that they
18:52 --> 18:54don't want to tell the other.
18:54 --> 18:56Both of them have fears
18:56 --> 18:57about what might happen,
18:57 --> 18:59and often they're the same fears.
18:59 --> 19:01So for patients and caregivers,
19:01 --> 19:05I usually encourage them to talk with each
19:05 --> 19:08other about what's going on because yes,
19:08 --> 19:11it's fine for the caregiver to try and
19:11 --> 19:14appear totally strong and able to do things.
19:14 --> 19:17And frankly, if it's a Hospice patient
19:17 --> 19:19and near the end of life, that's possible.
19:19 --> 19:23But by far more patients,
19:23 --> 19:25it's a much longer time that
19:25 --> 19:27they're going to be in treatment,
19:27 --> 19:29they're going to need care.
19:29 --> 19:31And so if it's not a sprint,
19:31 --> 19:33the caregiver has to take care
19:33 --> 19:35of him or herself as well.
19:35 --> 19:40And the other thing I think too is that
19:40 --> 19:44for some patients given a diagnosis and
19:44 --> 19:48I know I'm thinking of a particular friend
19:48 --> 19:52of mine whose husband was fairly young,
19:52 --> 19:57in his early 50s with a really poorly
19:57 --> 20:02differentiated sarcoma and the bad prognosis.
20:02 --> 20:05But was left in a bit of denial,
20:05 --> 20:09like this can't possibly be happening.
20:09 --> 20:13And can you talk a little bit about how
20:13 --> 20:17palliative care can kind of help patients
20:17 --> 20:20and caregivers accept a diagnosis?
20:20 --> 20:22Because I think that that's one
20:22 --> 20:24of the the most important things.
20:24 --> 20:27You can't really treat what you can't accept.
20:28 --> 20:31Well, that's a really good point.
20:31 --> 20:35First, I would say that different from
20:35 --> 20:39the person you said often people who
20:39 --> 20:42we think are in denial aren't in denial.
20:42 --> 20:45In that many patients I ask to see
20:45 --> 20:48because they say,
20:48 --> 20:49they're not facing their disease.
20:49 --> 20:50They're not in denial.
20:50 --> 20:52And when I go and talk with them,
20:52 --> 20:54the patient says, Oh no,
20:54 --> 20:56doc, I know what's going on.
20:56 --> 20:58I've got this cancer. I have to get treated.
20:58 --> 21:00If I don't, it's going to kill me.
21:01 --> 21:03I'm trying to be positive.
21:03 --> 21:07I'm trying to do the very best I can and,
21:07 --> 21:10you know, go at this disease in
21:10 --> 21:13a really active way and hoping
21:13 --> 21:16and thinking about beating it.
21:16 --> 21:18And that's not denial.
21:18 --> 21:20For the patients, however,
21:20 --> 21:23who really can't accept that they have it,
21:23 --> 21:24then, you know,
21:24 --> 21:27trying to beat them over the head to
21:27 --> 21:29get them to understand that isn't
21:29 --> 21:32really going to make a huge difference.
21:32 --> 21:36And so trying to work with them
21:36 --> 21:39gently in a way to, you know,
21:39 --> 21:41with open-ended questions when we see
21:41 --> 21:44them to try and get them to at least
21:44 --> 21:46think about what's happening with
21:46 --> 21:48their bodies and how important it can
21:48 --> 21:51be to get treatment for their family,
21:51 --> 21:52etcetera. But.
21:52 --> 21:55I certainly have some patients
21:55 --> 21:58who have ended up dying
21:58 --> 22:02eventually and still couldn't face it.
22:04 --> 22:07Or they can't accept the
22:07 --> 22:10prognosis and sometimes
22:10 --> 22:16when faced with a really poor
22:16 --> 22:20prognosis it is absolutely
22:20 --> 22:24something to try to
22:24 --> 22:28fight a disease and certainly
22:28 --> 22:31we have many therapies coming down
22:31 --> 22:33the Pike and clinical trials.
22:33 --> 22:36Which can certainly be helpful.
22:36 --> 22:38But at the same time,
22:38 --> 22:40given a certain diagnosis
22:40 --> 22:42at a certain time point,
22:42 --> 22:46I find that patients need to accept
22:46 --> 22:49the eventualities as they are unfolding
22:49 --> 22:52and sometimes that can be really hard
22:52 --> 22:55both for patients and for caregivers.
22:55 --> 22:57Can you talk about how you address that
22:57 --> 23:00in terms of end of life and getting
23:00 --> 23:02people to kind of come to terms with that?
23:04 --> 23:07Well, I guess where I start,
23:07 --> 23:09and I will often say this to patients,
23:09 --> 23:13is that the The Dirty secret of medicine
23:13 --> 23:16is that none of us get out of here alive.
23:16 --> 23:19Everybody, at least in 2022,
23:19 --> 23:22with no fountain of youth that I know of,
23:22 --> 23:24everybody is going to die one day.
23:24 --> 23:27And so the question is not if,
23:27 --> 23:31the question is how and when and
23:31 --> 23:35how is it going to be at the end.
23:35 --> 23:40And so I start from there and say, OK,
23:40 --> 23:44we have an uncertain amount of time
23:44 --> 23:46that you're going to be alive.
23:46 --> 23:47I have no idea.
23:47 --> 23:49It could be days, could be weeks,
23:49 --> 23:51could be months, could be years.
23:51 --> 23:54That's possible. I'd be surprised,
23:54 --> 23:55but it's certainly possible.
23:55 --> 23:58And so how are we going to give
23:58 --> 24:01you the best quality of life
24:01 --> 24:03hat you can have during this
24:03 --> 24:05uncertain amount of time?
24:05 --> 24:08And it's hard because we don't know
24:08 --> 24:10how long someone's
24:10 --> 24:12going to live,
24:12 --> 24:15I could die right now from a heart
24:15 --> 24:17attack while I'm talking to you.
24:17 --> 24:19It's certainly possible.
24:19 --> 24:23Working with patients to say
24:23 --> 24:26we can't stop you from dying.
24:26 --> 24:28But the oncologist is pushing,
24:28 --> 24:30trying to push your life as long as possible.
24:30 --> 24:33And if there isn't more treatment
24:33 --> 24:36and it is a Hospice situation,
24:36 --> 24:38then working with the patient again for
24:38 --> 24:41however long they're going to live to
24:41 --> 24:43make them as comfortable as they can
24:43 --> 24:46and to help them do whatever they need
24:46 --> 24:49to do before the end of their life.
24:50 --> 24:51And talk a little bit about
24:51 --> 24:53how you help the family members
24:53 --> 24:55and the caregivers with that,
24:55 --> 24:58because I think that that's the other
24:58 --> 25:00piece that is really tragic, right?
25:00 --> 25:03Is that watching somebody
25:03 --> 25:06that you love pass away
25:06 --> 25:08is almost worse than passing
25:08 --> 25:09away yourself sometimes.
25:10 --> 25:13Yeah, certainly
25:13 --> 25:15you were talking or we
25:15 --> 25:17were both talking about patients not
25:17 --> 25:19being able to face their disease.
25:19 --> 25:20Well, there's also,
25:20 --> 25:22there are also caregivers and
25:22 --> 25:24families who can't really face
25:24 --> 25:26that their loved one is sick and
25:26 --> 25:28that they have a cancer that
25:28 --> 25:31they're probably going to die from.
25:31 --> 25:35And so again having groups,
25:35 --> 25:37I strongly recommend going to
25:37 --> 25:39a group of people who have loved
25:39 --> 25:42ones who have a similar disease or
25:42 --> 25:44the same disease lung cancer or
25:44 --> 25:45liver cancer,
25:45 --> 25:49in order to compare notes with other
25:49 --> 25:52people and the talking about it can help.
25:52 --> 25:54It can help with understanding
25:54 --> 25:55what's going on.
25:55 --> 25:57It can really help knowing that
25:57 --> 25:59there are other people who are
25:59 --> 26:00going through the same thing.
26:00 --> 26:01You're not alone.
26:01 --> 26:02There are others
26:05 --> 26:07but it can be really hard and that
26:07 --> 26:10makes it more hard on the patient
26:10 --> 26:13if the family and caregiver can't
26:13 --> 26:15understand what's going to happen.
26:15 --> 26:19You don't want to, but yeah,
26:19 --> 26:22we need our social worker, chaplain.
26:22 --> 26:24We all try and support the person
26:24 --> 26:25while gently helping them come
26:25 --> 26:26to an understanding.
26:26 --> 26:29Yeah, the other situation I think,
26:29 --> 26:32which is particularly tragic is the
26:32 --> 26:36patient who doesn't have family.
26:36 --> 26:38What do you do in that circumstance?
26:38 --> 26:41We talked about how important having
26:41 --> 26:44caregivers and loved ones and family
26:44 --> 26:48with you as you go through cancer is.
26:48 --> 26:50Talk about what do you do in
26:50 --> 26:52the situation where somebody
26:52 --> 26:54doesn't have that support.
26:55 --> 26:58That can be tragic.
26:58 --> 27:02First I guess we try and
27:02 --> 27:05figure out if there really is no family.
27:05 --> 27:08And often it's whoever the best
27:08 --> 27:10person is in our team for talking
27:10 --> 27:12with the patient about this.
27:12 --> 27:14Sometimes there are children,
27:14 --> 27:16there are adult children,
27:16 --> 27:18but they have
27:18 --> 27:20not talked in 10 years
27:20 --> 27:21or something like that.
27:21 --> 27:24And so there are times when
27:24 --> 27:26there actually is family and
27:26 --> 27:29we try and encourage them to talk to the
27:29 --> 27:32family and say, this is what's going on,
27:32 --> 27:33if necessary,
27:33 --> 27:36I'm sorry for what I did and
27:36 --> 27:38trying to encourage that person
27:38 --> 27:41to come and be part of this,
27:41 --> 27:44to be a caregiver or at least to take
27:44 --> 27:46part in the rest of the person's life.
27:46 --> 27:49That is possible. If there is really
27:49 --> 27:52nobody in the family,
27:52 --> 27:56everyone has already died or only children
27:56 --> 27:57and no parents left,
27:59 --> 28:01again, trying to figure
28:01 --> 28:04out how best to take care of
28:04 --> 28:06this person at the beginning,
28:06 --> 28:08and for much of it, they may be fine.
28:08 --> 28:11They're able to live on their own,
28:11 --> 28:13but when they're not able to anymore,
28:13 --> 28:15when they're getting weak,
28:15 --> 28:16if they're going to die,
28:16 --> 28:19that's when we get Hospice involved
28:19 --> 28:22and with them hopefully try and
28:22 --> 28:24figure out what is possible.
28:24 --> 28:27How do we make sure that this person
28:27 --> 28:29gets the best care that we can?
28:29 --> 28:31Even though
28:31 --> 28:33there isn't a family member.
28:33 --> 28:35Doctor Andrew Putnam is an assistant
28:35 --> 28:37professor of clinical medicine
28:37 --> 28:38at the Yale School of Medicine.
28:39 --> 28:41If you have questions,
28:41 --> 28:43the address is canceranswers@yale.edu,
28:43 --> 28:45and past editions of the program
28:45 --> 28:48are available in audio and written
28:48 --> 28:49form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public Radio.
28:55 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Pain and Symptom Management for Cancer Patients with guest Dr. Andrew Putnam January 22, 2023 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095