Dr. Cohen received the 2001 Dorothy J. Lamont Scientist Award for her work in palliative care for cancer patients, the largest group of patients receiving this type of care. The award is given to young and upcoming cancer researchers. It is offered jointly by the Canadian Institutes of Health Research (CIHR) and the National Cancer Institute of Canada (NCIC) and provides the recipient with five years of funding.
To evaluate the quality of life of terminally ill patients, Dr. Cohen has developed the "McGill Quality of Life (MQOL) Questionnaire" with Dr. Balfour Mount, a professor and the Eric M. Flanders Chair of Palliative Medicine at McGill. The questionnaire measures existential, physical, psychological, and social well-being. It measures positive as well as negative contributions to quality of life. It does ask about physical symptoms but also probes the patients’ psychological status, outlook on life and level of "meaningful existence as well as perceived support."
While the McGill questionnaire is a good measure of a patient’s quality of life, the fact remains that not all patients have adequate access to end-of-life care. "Right now [palliative care] is unevenly available," says Dr. Cohen. "People are often referred to us too late – sometimes in the last days, last few weeks when they could have benefited from the care much earlier on." She believes doctors should make more of an effort to recommend palliative care facilities and to do so at an early stage. She admits "it’s not a popular topic – especially among physicians who view it as a failure. Most went into medicine to save lives rather than quality of life." To many doctors, recommending palliative care means admitting defeat.
Pain management is another important aspect of palliative care. Physicians often forget the role of cognition and emotion in treating patients’ pain. Dr. Cohen points out "pain is a perception. It’s not a sensation. It’s not only related to tissue damage." Having trained under McGill psychologist Ronald Melzack, a world pioneer in pain research, Dr. Cohen believes in addressing the other aspects of patients’ pain such as the spiritual, psychological and cognitive distress. Even if the patient’s disease is incurable, the pain can be managed in a way that quality of life is improved by an interdisciplinary health care team.
By finding out what patients want from a palliative care service and improving health care provider education on the topic, staff can then work on improving care and making patients more comfortable. Dr. Cohen is doing her part by delving deeper into the psychological and existential side of things. She has already been able to show that admission to a palliative care unit will improve quality of life in more than just the physical domain. But so far, she notes, "it’s been a group of people without much voice." Dr. Cohen is trying to change this and to help patients find their voice so that health care providers and administrators can hear what they have to say about fully living their final stage of life.
This is the fourth in a series of interviews with McGill pain researchers whose investigations are funded by the Canadian Institutes for Health Research. The project, carried out in cooperation with The McGill Office for Chemistry and Society, aims to highlight recent advances in the study of pain. Permission is granted to reprint in whole or in part.