This study will investigate the most effective approach for managing pain and providing
palliative care (lessening of pain or symptoms).
Patients with advanced cancer who are enrolled in a National Cancer Institute (NCI) protocol
and will undergo major surgery as part of their treatment may be eligible for this study.
Participants will be randomly assigned to pain management provided by either 1) their
attending physician or 2) the Clinical Center's Pain and Palliative Care Service. Patients
in the first group may be reassigned to the Pain and Palliative Care Service at any time
during the study.
Participants will be interviewed every 3 months for as long as 1 year about their pain, its
effect on several areas of their lives, changes in their needs, and how well they think
their pain is being managed.. As the patients progress through the NCI study, they will meet
regularly and as often as needed with either their attending physician or the Pain and
Palliative Care team. Each interview will last about 20 to 30 minutes. With the patient's
permission, the interviews will be tape recorded.
Pain is multidimensional. It is more than simply a physiologic or sensory response. Pain
management programs are best developed by selecting interventions based on the individual's
pain experience. Strategies with several mechanisms of action that complement each other
might be selected to work together, thereby maximizing pain relief. The goal of palliative
care is to achieve the highest possible quality of life for patients and their families
through symptom control and attention to the whole patient, where physical, psychosocial,
emotional, and spiritual dimensions are addressed. Provision of relief from pain and
distressing symptoms is best served by a specialized interdisciplinary team with a
comprehensive approach. The continuity of care for the patient and family is supported by
communication and a strong partnership with the primary biomedical research team and the
palliative care team.
Despite a number of descriptive studies exploring the effectiveness of specialized pain and
palliative care teams, the paucity of good evaluations, with any comparative design,
urgently needs to be addressed. This is a randomized, repeated measures, evaluation study to
explore the effectiveness of the inpatient Pain and Palliative Care Service intervention.
The data collected during this study will not only include outcomes of the intervention, but
also patient and family perceptions of the care delivery process including issues
surrounding communication with health care providers. Patients with advanced malignancies
who are currently participating in NCI Surgery Branch protocols will be asked to participate
in a pain and symptoms management evaluation study. Each patient and a designated family
member will be asked to complete a series of questionnaires over time exploring physical,
psychosocial and emotional correlates of pain and symptom management. Data will be analyzed
using multivariate statistics.
Patients with advanced malignancies who are currently undergoing major surgical procedures
in NCI Surgery Branch will be recruited to participate in a pain and symptoms management
Inclusion criteria are stated in the parent protocols.
Although each patient will be asked to identify a family member/significant other to
participate in the study, patients will be eligible for inclusion regardless of whether
they identify a family member for participation in the family questionnaires.
All exclusions are stated in the NCI Surgery Branch parent protocols.