Caring for patients with chronic pain: pearls and pitfalls.

Chronic, nonmalignant pain is a substantial public health problem in the United States. Research over the past 2 decades has defined chronic pain by using a "biopsychosocial model" that considers a patient's biology and psychological makeup in the context of his or her social and cultural milieu. Whereas this model addresses the pathology of chronic pain, it also places many demands on the physician, who is expected to assess and manage chronic pain safely and successfully. There is a growing body of evidence suggesting that opioids can be effective in the management of chronic pain, but there has also been a rise in opioid-related overdoses and deaths. Clinicians should be aware of assessment tools that may be used to evaluate the risk of opioid abuse. A basic understanding of chronic pain pathophysiology and a uniform approach to patient care can satisfy the needs of both patients and physicians.

Integration of palliative medicine into routine oncological care: what does the evidence show us?

Palliative medicine is now a recognized medical subspecialty. The goal of palliative medicine is to prevent and relieve suffering, and to support the best possible quality of life for patients and their families, regardless of the stage of their illness.(1) Typically, palliative medicine teams consist of multiple disciplines (such as physicians, advanced practice nurses, social workers, and chaplains) to address several domains of the patient experience. Medical oncologists have routinely provided palliative care to their patients along with antineoplastic therapy. Nevertheless, there is a recognized need for an improvement in palliative care delivery to the patient with advanced cancer. This narrative review outlines recent clinical trials of palliative care being integrated into routine oncological care.

American society of clinical oncology statement: toward individualized care for patients with advanced cancer.

Patients with advanced incurable cancer face complex physical, psychological, social, and spiritual consequences of disease and its treatment. Care for these patients should include an individualized assessment of the patient's needs, goals, and preferences throughout the course of illness. Consideration of disease-directed therapy, symptom management, and attention to quality of life are important aspects of quality cancer care. However, emerging evidence suggests that, too often, realistic conversations about prognosis, the potential benefits and limitations of disease-directed therapy, and the potential role of palliative care, either in conjunction with or as an alternative to disease-directed therapy, occur late in the course of illness or not at all. This article addresses the American Society of Clinical Oncology's (ASCO's) vision for improved communication with and decision making for patients with advanced cancer. This statement advocates an individualized approach to discussing and providing disease-directed and supportive care options for patients with advanced cancer throughout the continuum of care. Building on ASCO's prior statements on end-of-life care (1998) and palliative care (2009), this article reviews the evidence for improved patient care in advanced cancer when patients' individual goals and preferences for care are discussed. It outlines the goals for individualized care, barriers that currently limit realization of this vision, and possible strategies to overcome these barriers that can improve care consistent with the goals of our patients and evidence-based medical practice.

Addressing Fertility in Patients With Advanced Cancer: How the Quality Oncology Practice Initiative Standards and ASCO Guidelines Facilitate Ethical Communication.

The ASCO Recommendations on Fertility Preservation in Cancer Patients were issued in 2006, but evidence suggests many oncologists are unaware of the guidelines and are reluctant to initiate conversations pertaining to fertility with patients.