[Some deliberations on the care of terminally ill cancer patients with severe pain.].
When treating a cancer patient with severe pain it is not sufficient to treat the cancer and the pain. Effective therapy must adhere to the principles of psychosomatic medicine, i.e., the disease, cancer, isnot treated, but instead a human being who is suffering from this disease, has severe, ongoing pain as a result, and is going to die. Irrespective of the question of whether the patient has been told his diagnosis or not, he will be in an extreme situation psychologically, as he instinctively suspects what is wrong with him. Pain indicates that the cancer is advanced; this can be compared with a death sentence, the execution of which has not yet been definitely scheduled. In these cases continuing care is more important than formal therapies. Above all, a cancer patient fears "intractable" pain, the prospect of being helpless because of physical deterioration, and imminent death which is no longer hypothetical. In order to assure adequate pain therapy, the pain medication must be continuous and sufficient, administered on a regular basis and given irrespective of whether there might be side effects or not. This requires that there be a relationship of confidence between the physician and patient in order to ensure compliance of treatment. As morphine is the most powerful analgesic drug, it can and must be given at an early stage. The fear of impending helplessness can be reduced by the physician "accompanying" the patient providing loving care, and assuring the patient that he will have somebody to rely on when he needs it. The most important way to solve such problems is to have a dialogue addressing the problems. Verbalization of fears can resolve them; even fear of death can be reduced when it is addressed in a dialogue. Advanced cancer patients are mostly remote from everyday life; they no longer take part in it. If, however, they receive the proper guidance, they will live more consciously and more intensively. In the awareness of imminent death they can experience every day of their life as a gift. Care of terminally ill cancer patients with severe pain thus also must include a guided approach to death.
Schara
J
J
Institut für Anästhesie am Klinikum Barmen Kliniken der Stadt Wuppertal, Heusnerstraße 40, D-5600, Wuppertal.