"We know between six to ten percent of the general population become addicted so naturally some oncology patients will come to us with this problem," said Kedziera. "Misconceptions and stereotypes have forced some clinicians to feel uncomfortable prescribing medication for the fear that it will be misused or wind up in the wrong hands. The oncology nurse can serve as a point person for both the suffering patient and the attending physician. We need to take care of all patients with pain. We should not deny comfort for the majority because we fear we might unknowingly treat someone with an addiction problem."
Oncology patients with current or past drug abuse present an intricate set of physical and psychosocial issues that can complicate their cancer treatment and pain symptom management. Though, these patients still have a right to pain control, Kedziera said. "Patients have a right to a better quality of life, regardless of their current or past history," continued Kedziera. "Our responsibility as nurses is to provide the individual patient will the best care possible. There are ways to safely manage their pain. Good pain management equals good cancer care."
A nurse educated in pain management will spend extra time with the patient to perform a complete assessment and design a multidisciplinary care plan. These individuals have two disease entities that require treatment, the disease of addiction and the problem of cancer pain, Kedziera said.
According to Kedziera, the gap in cancer pain management is a result of lack of time and education. "While the primary role of the physician is to treat the disease, nurses focus on symptom management." said Kedziera. "Collaboratively, the nurse and physician can develop a treatment strategy and spend the appropriate time treating each facet of the patient's case."
In the Pain Management Center at Fox Chase, every patient receiving prescription medicine must sign a contract, which outlines the responsibilities of both the treatment team and the patient. "This agreement essentially says that the pain management team will work to relieve the pain if the patient agrees to collaborate and be truthful. The patient is given instructions on contacting the team, how to use the medicines and behaviors that can't be tolerated for safety reasons," said Kedziera. "If the patient breaks their word, we have to re-visit how we manage that patient's pain."
A complete pain management center, such as the one at Fox Chase, offers a group of pain specialists available to patients 24 hours a day, seven days a week. Social workers are also among the resources available to patients who present a complex case.
Kedziera is a clinical nurse specialist who is among the staff of Fox Chase nurses who, in 2000, were recognized for excellence with the Magnet Award. Nurses at Fox Chase not only specialize in oncology, but further concentrate within a particular field allowing them to provide the most up-to-date treatment.
Also presenting with Kedziera are Betty Ferrell, PN, PhD, FAAN of City of Hope in Los Angeles, Ca. and Jeannine Brant, RN, MSN, AOCN of St. Vincent Hospital in Billings, Montana.
Fox Chase Cancer Center was founded in 1904 in Philadelphia, Pa. as the nation's first cancer hospital. In 1974, Fox Chase became one of the first institutions designated as a National Cancer Institute Comprehensive Cancer Center. Fox Chase conducts basic, clinical, population and translational research; programs of prevention, detection and treatment of cancer; and community outreach. For more information about Fox Chase activities, visit the Center's web site at www.fccc.edu or call 1-888-FOX CHASE.