title: Locally invasive and metastatic endometrial cancer: multiple issues functioning in a multidirectional manner.
abstract: A 32-year-old woman with locally invasive and metastatic endometrial cancer was admitted to the hospital for the treatment of crescendo pain. The effectiveness of her medical and psychosocial care was mitigated by four issues: (1) the intractable nature of her pain, (2) substance abuse, (3) mental illness, and (4) interorganizational conflict. This case report is both a chronicle and review of the literature of these multiple issues that converged together to adversely effect the patient's overall care.
authors.affiliation: Medicine Associates, Weston, Connecticut, USA.
authors.forename: Bruce Z
authors.initials: BZ
authors.lastname: Kaplan
authors.forename: Reed
authors.initials: R
authors.lastname: Phillips
authors.forename: Dan
authors.initials: D
authors.lastname: Ratner
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003220:Conflict, Psychological; D003248:Constipation / Q000139:chemically induced / Q000628:therapy; D017831:Diagnosis, Dual (Psychiatry); D016889:Endometrial Neoplasms / Q000150:complications* / Q000523:psychology / Q000556:secondary; D017809:Fatal Outcome; D005260:Female; D006738:Hospices; D006801:Humans; D007278:Injections, Spinal; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine