Managing addiction in advanced cancer patients: Why bother?

The management of addiction in patients with advanced cancer can be time-co nsuming; labor-intensive, and difficult. Some clinicians believe that it is not worth the effort, due In part to a failure do appreciate the deleterio us impact of addiction on palliative care efforts and a view of addiction a s intractable in any case. Indeed it is possible that some clinicians Lt pe rceive addiction not only fatalistically but, because of common misconcepti ons , believe that managing or attempting to decrease the patient's use of alcohol or illicit substances would be tantamount to depriving a dying,pati ent of a source of pleasure. In this paper we argue that managing addiction is an essential aspect of palliative care for, chemically-dependent and al coholic patients. The goal of such efforts Is not complete abstinence, but exerting enough control over illicit drug and alcohol use to allow palliati ve care interventions to decrease suffering. To illustrate this view, we de scribe two patients with chemical-dependency. We highlight the impact of un checked substance abuse on patients perpetuation of their own suffering, th e complication of symptom management, the diagnosis and treatment of mood/ anxiety disorders, and the effect on the patients' family; and caregivers. (C) U.S Cancer Pain Relief Committee, 2000.