By Ruben Mesa, MD
2008-12-06
Analgesia? Growth factors? Transfusions? Palliative chemotherapy? In the challenging and heterogeneous patient care situations in which hematologists find themselves, the distinction between “therapy” and “supportive care” is a blurry line open to interpretation. Many things enter into this interpretation, such as is the patient able to be cured, or will the patient likely die from his or her disease? Is his or her symptom from disease, a complication of therapy, or both? Are we (hematologists) prolonging life or alleviating suffering? Few topics remain as clinically important, yet enigmatic, as supportive care in hematology.
Today at 7:30 a.m. in Room 2002-2004-2006 – West a discussion on supportive care will come into focus with a session on Pain Management and Supportive Care for Patients with Hematologic Disorders, chaired by Matthew J. Loscalzo, MSW, administrative director of the Sheri & Les Biller Patient and Family Resource Center in Duarte, CA. Although there are many areas that could be explored in a field as broad as hematology, this year’s session will focus on three distinct issues.
Dr. Lennette Benjamin, from the Comprehensive Sickle Cell Center at Montefiore Medical Center, will challenge us with a discussion on pain management in patients with sickle cell disease. This discussion titled “Pain Management and Sickle Cell Disease: Palliative Care Begins at Birth” examines the chronic and frequently inadequately treated pain that patients with sickle cell disease face. Additionally, the frequent and often inappropriate concern of health-care providers regarding narcotic abuse or dependence and the need for an interdisciplinary care model across the continuum of a patient’s life and disease will be discussed.
The discussion in this session switches to the challenges faced by patients with advanced hematologic disease, frequently of malignant nature, when Dr. Janet Abrahm, of the Dana-Farber Cancer Institute, discusses “Patient and Family Requests for a Hastened Death.” The focus of this discussion is the unspoken concerns of family members and patients underlying the requests for a hastened death: fear of pain, loss of dignity, and fear of being a burden to others. This session, built around a case discussion, should provide an interesting, challenging, and interactive session.
The final talk, led by Mr. Matthew Loscalzo, will describe the challenges of palliative care medicine (and the many psychosocial implications) and how this is woven into the emotionally charged environment of the intensive care unit. Practical aspects of establishing realistic goals for care among all those involved and how to bring stability and meaning to the medical process through these interactions will be discussed.
Grab a cup of coffee and consider participating in this interactive and challenging session regarding palliative and supportive care in our patients. The issues involved are much deeper than the latest combination of chemotherapy agents for a specific disease and raise questions we all face and share in the care of our patients.
If you miss this session today, plan to attend the same session tomorrow morning (same time, same place).
Dr. Mesa indicated no relevant conflicts of interest.
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