Prostate Cancer Lab #32: Palliative Care for Prostate Cancer (Tom Smith)

Advanced cancer patients experience many mental and physical symptoms from the disease, including pain, depression, anxiety, nausea, constipation, neuropathy, urinary problems, and sexual problems, and their family also experiences mental stress. To relieve these symptoms and improve quality of life for both the patient and the family, palliative care provides medications, nutritional changes, relaxation techniques, and emotional and spiritual support.

Dr. Tom Smith has a unique perspective on how people experience advanced cancer because he is not only a physician treating patients with breast cancer, but he is also a prostate cancer survivor. He has been a pioneer in bringing palliative care to cancer patients and to the mainstream of medical practice.

What is palliative care?

Palliative care can be thought of as addressing three circles of services around the patient and family:

1. Symptoms (physical and mental): such as pain, depression, anxiety, how you’re coping, nausea, constipation, urinary problems, sexual health problems, erectile problems.
2. Support: Who’s supporting you on this journey? Do you have enough support? Who’s family for you? Are they available nearby? Do you need help with activities of daily living? Do you have a religious or spiritual community?
3. Advanced care planning: Do you need a living will? Do you have an Advanced Directive? If you got so sick that you couldn’t speak for yourself, who would you want to make medical decisions for you?

What are the benefits of palliative care?

When cancer patients are seen by palliative care alongside their oncologist they live longer, and they live better. You’ve got this whole team whose job is to relieve your symptoms. They may check in with you once a week. Are you bothered by pain? Are you bothered by shortness of breath? Are you bothered by nausea? Fix those things, and people live six months longer than if they didn’t have the palliative care team involved. The data also show that palliative care does a better job when it is involved early in the care of patients, rather than waiting until the last three or four days before they are going to die and scurrying around trying to relieve their pain. Every advanced cancer patient should be seen by palliative care within eight weeks of diagnosis.

How should I behave to best manage my symptoms?

Be honest with yourself, and be honest with your providers about symptoms you’re having. Be open. If a bone hurts, or if you’re short of breath, tell somebody about it. If you’re having feelings of depression, anger, or frustration, it’s much easier to share those with somebody. Get some help with them. Some people don’t want to be a bad patient, and they think that if they complain too much, then the doctor is going to stop their therapy. That’s not the case. The providers need to know so they can help.

What are some tips for addressing various physical and mental symptoms?

• For neuropathy: menthol, scrambler therapy, auricular acupressure, or ear acupressure.
• For hot flashes: Oxybutynin (Distropan) works for men and women. Other drugs, such as Gabapentin (Neurontin), Duloxetine (Cymbalta), and Venlafaxine (Effexor), work for women but have almost no effect for men. Embr Wave bracelet. Structured breathing. Stellate ganglion block.
• For anxiety: Gabapentin, mental health care professional.
• For orgasms for men: silicone-based lubricant.
• For total pain management: yoga, meditation, meditation apps, e.g., Calm, ThisIsKara.
• For androgen deprivation therapy: exercise.