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Hello everyone,
MS4 matching into Anesthesiology but have a sincere interest in advancing palliative care - especially terminal cancer pain management. My passion stems from a very close family member of mine who died from cancer.
My plan is to finish Anesthesiology residency follow by Pain Management, Regional Anesthesia, and finally Palliative Care Fellowship. I want to contribute to the field by bringing in techniques from anesthesia to palliation. (I started a thread in the Anesthesiology forum: http://forums.studentdoctor.net/showthread.php?t=563847.) I see GREAT POTENTIAL in Anesthesiology in contributing to Palliative Medicine.
I was wondering if you can directed me to links/resources regarding a career/research/fellowship in Palliative Care.
Thank you very much!
Palliative Care in Geriatric Anesthesia
Palliative medicine is a recent addition to the list of medical subspecialties. In late 1987, the Royal College of Physicians of London recognized palliative medicine as a specialty within general internal medicine. Palliative care arose out of the change from acute to chronic causes of death. Currently the emphasis of health care is on improving the quality of life. Palliative care has received increasing attention in the United States as the debate over euthanasia and AIDS have become political "hot button" issues.
It is now well established that a primary cause for a chronically ill patient to consider euthanasia involves the lack of adequate pain control, especially if the patient is already suffering from a terminal disease process. As the current generation ages, there will likely be an increase in the numbers of people dying from cancer. There is an anticipated 20 percent increase in men and a 12 percent increase in women dying from cancer between 1980 and the turn of the century. A study by Cartwright found that 84 percent of surviving relatives reported that cancer patients suffered pain in the last year of life.
The World Health Organization (WHO) has also realized the efficacy of palliative care. In 1990, a WHO expert committee on cancer pain relief and palliative care suggested that 30-50 percent of cancer patients are experiencing pain or being treated for it. In an effort to advance the cause, the WHO provides this definition of palliative care:
* Affirms life and regards dying as a normal process
* Neither hastens nor postpones death
* Provides relief from pain and other distressing symptoms
* Integrates the psychological and spiritual aspects of patient care
* Offers a support system to help the family cope during the patientâs illness and in their own bereavement.
In short, palliative medicine is the active total care of patients whose disease is not responsive to curative treatment. This requires a multidisciplinary approach to treat symptoms, control pain and address the psychological, social and spiritual needs of the patient. Palliative care can be provided with less expense and can provide more satisfaction to the patients and their families.
The anesthesiologist, especially the anesthesiologist trained in pain management, should be a member of the multidisciplinary palliative care team. Given the fact that the primary complaint of terminal patients is pain, the anesthesiologist should be central in the palliative medicine model. There is no other medical/surgical specialty that can provide the medical and procedural expertise allowing a patient to remain functional until they die.
Cancer pain may be somatic or visceral due to tumor invasion. Terminal patients may also present with neuropathic, sympathetically mediated and centrally mediated pain either due to their end-stage disease or the treatment of the diseases. The anesthesiologist is uniquely trained to differentiate and treat these differing pain entities.
Providing medical management for pain to include non-narcotic analgesics, narcotics (with all their modes of administration), anticonvulsants, local anesthetics, steroids and sympathetic nervous system antagonists may not be the sole purview of anesthesiologists; members of other specialties may be well trained in all of these medical regimens. On the other hand, many medical specialists may not feel comfortable using narcotics in the doses sometimes required to ease the pain of the terminal patient.
After defining the pain syndromes of the palliative care patient, there are procedural skills the anesthesiologist possesses that aid in pain control, including epidural and/or intrathecal administration of narcotics via implantable pumps, chemical neurolysis of nerve roots and sympathetic ganglia, cryoanalgesia, radiofrequency ablation, TENS units and dorsal column stimulators. Many of these interventions provide long term, patient-controlled analgesia, thereby allowing the patient to continue to function and perform their activities of daily living.
There is little research that specifically addresses the utility of the anesthesiologist in palliative care. Future work in this area will be vital in expanding the role of the anesthesiologist as a perioperative physician.
MS4 matching into Anesthesiology but have a sincere interest in advancing palliative care - especially terminal cancer pain management. My passion stems from a very close family member of mine who died from cancer.
My plan is to finish Anesthesiology residency follow by Pain Management, Regional Anesthesia, and finally Palliative Care Fellowship. I want to contribute to the field by bringing in techniques from anesthesia to palliation. (I started a thread in the Anesthesiology forum: http://forums.studentdoctor.net/showthread.php?t=563847.) I see GREAT POTENTIAL in Anesthesiology in contributing to Palliative Medicine.
I was wondering if you can directed me to links/resources regarding a career/research/fellowship in Palliative Care.
Thank you very much!
Palliative Care in Geriatric Anesthesia
Palliative medicine is a recent addition to the list of medical subspecialties. In late 1987, the Royal College of Physicians of London recognized palliative medicine as a specialty within general internal medicine. Palliative care arose out of the change from acute to chronic causes of death. Currently the emphasis of health care is on improving the quality of life. Palliative care has received increasing attention in the United States as the debate over euthanasia and AIDS have become political "hot button" issues.
It is now well established that a primary cause for a chronically ill patient to consider euthanasia involves the lack of adequate pain control, especially if the patient is already suffering from a terminal disease process. As the current generation ages, there will likely be an increase in the numbers of people dying from cancer. There is an anticipated 20 percent increase in men and a 12 percent increase in women dying from cancer between 1980 and the turn of the century. A study by Cartwright found that 84 percent of surviving relatives reported that cancer patients suffered pain in the last year of life.
The World Health Organization (WHO) has also realized the efficacy of palliative care. In 1990, a WHO expert committee on cancer pain relief and palliative care suggested that 30-50 percent of cancer patients are experiencing pain or being treated for it. In an effort to advance the cause, the WHO provides this definition of palliative care:
* Affirms life and regards dying as a normal process
* Neither hastens nor postpones death
* Provides relief from pain and other distressing symptoms
* Integrates the psychological and spiritual aspects of patient care
* Offers a support system to help the family cope during the patientâs illness and in their own bereavement.
In short, palliative medicine is the active total care of patients whose disease is not responsive to curative treatment. This requires a multidisciplinary approach to treat symptoms, control pain and address the psychological, social and spiritual needs of the patient. Palliative care can be provided with less expense and can provide more satisfaction to the patients and their families.
The anesthesiologist, especially the anesthesiologist trained in pain management, should be a member of the multidisciplinary palliative care team. Given the fact that the primary complaint of terminal patients is pain, the anesthesiologist should be central in the palliative medicine model. There is no other medical/surgical specialty that can provide the medical and procedural expertise allowing a patient to remain functional until they die.
Cancer pain may be somatic or visceral due to tumor invasion. Terminal patients may also present with neuropathic, sympathetically mediated and centrally mediated pain either due to their end-stage disease or the treatment of the diseases. The anesthesiologist is uniquely trained to differentiate and treat these differing pain entities.
Providing medical management for pain to include non-narcotic analgesics, narcotics (with all their modes of administration), anticonvulsants, local anesthetics, steroids and sympathetic nervous system antagonists may not be the sole purview of anesthesiologists; members of other specialties may be well trained in all of these medical regimens. On the other hand, many medical specialists may not feel comfortable using narcotics in the doses sometimes required to ease the pain of the terminal patient.
After defining the pain syndromes of the palliative care patient, there are procedural skills the anesthesiologist possesses that aid in pain control, including epidural and/or intrathecal administration of narcotics via implantable pumps, chemical neurolysis of nerve roots and sympathetic ganglia, cryoanalgesia, radiofrequency ablation, TENS units and dorsal column stimulators. Many of these interventions provide long term, patient-controlled analgesia, thereby allowing the patient to continue to function and perform their activities of daily living.
There is little research that specifically addresses the utility of the anesthesiologist in palliative care. Future work in this area will be vital in expanding the role of the anesthesiologist as a perioperative physician.
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