Surgical oncology clinics of North America
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Surg. Oncol. Clin. N. Am. · Jan 2001
ReviewThe relationship between surgery and medicine in palliative care.
Palliative care represents the beneficence of surgery and medicine. A unified approach toward symptom control in patients with advanced diseases by surgeons and physicians is essential. Proposals are put forward to develop relationships between surgery and medicine for palliative care, teaching, and research. A model for integrating surgical and medical services to deliver the best palliative care is presented in this article.
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Because most cancer pain involves multiple anatomic sites, invasive techniques are intended to be analgesic adjuvants and not serve as the definitive treatment. These procedures often allow patients to reduce their dosages in their current drug regimens or to derive greater pain relief from their present doses in order to improve their quality of life. Medical care of the suffering pain patient requires a multimodality, multispecialty approach combining psychotherapy, social support, and pain management to provide the best possible quality of life or quality of dying.
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Most advanced cancer patients remain incurable. They are carrying the tumor burden and the burden of symptoms as a result of physical, emotional, and spiritual distress. ⋯ Because of this, palliative medicine has emerged as the champion of pain and symptom control in advanced cancer patients. The reasons for medical oncology not embracing palliative care are analyzed and a model for palliative medical oncology is proposed.
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Surg. Oncol. Clin. N. Am. · Jan 2001
ReviewThe surgeon and palliative care: an evolving perspective.
This article examines some of the cognitive and psychologic barriers surgeons possess when attempting to palliate advanced and incurable disease. Despite these barriers, the history of surgery demonstrates numerous eloquent exponents of palliative care philosophy. The considerable body of knowledge and experience in these matters beginning with the work of Dame Cicely Saunders and subsequent medical specialists is presented and offered as a guide for surgeons as their own perspective continues to evolve.
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In the area of end-of-life bioethical issues, patients, families, and health care providers do not understand basic principles, often leading to anguish, guilt, and anger. Providers lack communication skills, concepts, and practical bedside information. ⋯ Clinicians need to learn how to balance the benefits and burdens of medications and treatments, control symptoms, and orchestrate withdrawal of treatment. Finally, all need to learn more about the dying process to benefit society, their own families, and themselves.