Cancer Pumps: The First Visit

Cancer patients are often emotionally unprepared for discussions about intrathecal pump therapy. They may view the pump as an admission of defeat rather that a useful tool to help them fight back against the cancer. Before you can begin to relieve their pain you must first breakthrough and reach them on an emotional level.

Cancer pain was one of the first uses of intrathecal pump therapy and it remains one of the most important. The relative potency of drugs administered directly onto the spine as opposed to pills or injections allows for far greater relief of pain and a far lower incidence and severity of side effects.

 

The trialing procedure with cancer pumps is similar to, but is attended by a greater sense of urgency than the trials done for other types of pain. This is because the cancer patient is usually brought to our office by an acute exacerbation of their chronic cancer pain precipitating a sudden failure of oral therapy. In addition many patients know very little about interventional pain techniques and are emotionally unprepared for the trialing process and the possibility of having a pump actually implanted into their bodies.

 

We have learned over the years that no one wants to have a device implanted when they first hear of it and despite terrible pain most patients leave without starting a trial. Some of this may be because many cancer patients view the implantation of a pump as an admission of defeat, which is definitely not true. A great deal of time is spent during the initial visit dispelling myths such as this. We explain that the implantation of an intrathecal pump is actually an aggressive move to conserve and bolster the bodies own natural defense mechanisms used to fight the cancer. We explain about how unrelieved pain changes hormone levels and the body’s metabolism in adverse ways. We explain how large does of narcotics also have adverse effects on appetite, metabolism and the immune system. Finally we explain to the patients that not only are pump patients more comfortable, that numerous studies have show that the live longer.

 

Even if they say that they are not sure that they want a pump, we still go over all of the details of trialing and implantation with them. They get a chance to touch the external trialing pump along with its fanny pack and an imitation infusion mixture. The also get to hold and examine a dummy version of an implantable Synchromed II infusion pump. This gives them a sense of the human dimensions of intrathecal therapy.

 

All of our patients leave with a packet containing three important resources, a small booklet describing the therapy and trialing process, a DVD showing patients and responses to therapy and the URL of the Medtronic website which is replete with useful information as well as directions for enrolling in their “Ambassador Program” where they can be put in contact with real patients suffering from the same disease and the same type of pain they have. Patients usually find this to be very helpful and just in case they think that the Medtronic database of patients is rigged or that somehow patients in Minneapolis or Cleveland are somehow different than the people in Burbank we tell them about the large number of cancer patients in the practice who are more than happy to share their experiences.

 

Finally all of the patients are given a return appointment, just to discuss the therapy and their concerns about it. We encourage the patients to bring as many family members or friends as they like to the appointment, because we know that this is a big decision and having your support group with them seems to make the whole process easier.

 

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