Alberta Cancer Foundation

House of Pain (Management)

Almost 25 years ago, Renée Lee graduated from nursing school. Since then she has had a rewarding career – for 18 years she assisted inpatients on the surgical oncology ward at the Foothills Hospital and, for another three, helped patients with wound and ostomy care. She felt honoured to work with people dealing with acute issues that needed immediate and time-limited attention.

Photos by Brian Buchsdruecker

But two years ago, while looking for more hours and wanting to contribute more to the welfare of patients beyond their surgical experiences, she took on a three-days-per-week job at a facility next door to the hospital. She is a nurse of the Supportive Oncology Clinic, commonly referred to as the Pain Clinic, but “we do more than pain,” says Lee. She also helps cancer patients deal with symptoms such as fatigue and nausea. At the clinic in the Tom Baker Cancer Centre, she is part clinician, part navigator and part innovator.

The Supportive Oncology Clinic – comprising Lee, two physicians and two pharmacists – conducts two, three-to-four hour sessions a week for people dealing with pain associated with cancer. During these sessions, patients are assessed and given a treatment regimen. Lee takes referral calls from patients, from family members, doctors or hospital colleagues. The clinic sees patients within two weeks of referral, and they are redirected if the pain issue does not have an accompanying cancer diagnosis. “We try to work patients in so they can be seen in a timely manner,” says Lee. “These patients have so many things on their plates already. We need to deal with them quickly.”

Presenting cancers run the gamut – from breast to lung, from brain to blood. Lee has had to become a generalist, in learning the basic etiology and treatments of many cancers.

And the pain varies as well. There is the pain of a new cancer, when a growing tumor presses on a nerve, for example. A person who lives with chronic pain from another condition may have trouble managing the treatment associated with a new cancer diagnosis; perhaps he or she cannot comfortably lie down for radiation therapy and may require sedation. Someone taking radiation therapy for a head-and-neck cancer may need advice dealing with the pain of eating or swallowing. Chemotherapy often results in debilitating nerve pain that needs attention, or there might be pain stemming from a previous cancer and associated treatments. Occasionally, the pain might not even be associated with the cancer; the hand pain of a recent patient was found to be carpal tunnel versus cancer-related neuropathy. Night-time splints offered relief.

Solutions for pain range from medication to adjustments in treatment protocol. For example, the person with lower back pain may be able to manage shorter periods of radiation therapy. After they visit the clinic, Lee follows up with patients by phone to track their progress or to tweak their plan. There are up to 15 patients attending each clinic and up to five new referrals each week, says Lee. “Our clinics are busy.”

But Lee and her team members are a resourceful bunch. They will squeeze in patients or – if patients are unable to make the clinic hours – see them when they are at the Tom Baker for other consults or treatments.

During the telephone intake process, Lee asks a variety of questions related to pain and other aspects of the cancer experience. She checks for eating habits, sleeping patterns, nausea and fatigue, social support and depression. She will refer patients for home care support or to social workers or dieticians, as necessary. “This is all about team-based care to better meet patients’ comprehensive needs.”

Often getting to the root of the discomfort is a complex process. If a patient is feeling nauseated, is that from chemotherapy drugs or the ongoing prescription medication or both? “We try to figure out which is which and deal with symptoms,” says Lee. Pain, she says, is manageable; it’s just a matter of finding the right combination of treatment, medications and timing.

Lee’s colleagues and patients admire her optimistic and dedicated approach to managing the pain and discomfort. Sonya Caruth, transition services co-ordinator at the Tom Baker, describes Lee as “a calm, concerned professional who has a good sense of humour. She’s a team player who puts the needs of the patients first.” But maybe the best review came from a patient, just days before he died. “I am so glad to be home and not in pain,” he told Caruth.

There are challenges with the work. It is frustrating when referrals come in later than they should, resulting in some clinic attendees being severely debilitated. And the emotional toll of seeing people in protracted pain is difficult. But Lee deals with stress by keeping to a part-time work schedule, hiking in the mountains, running, spending time with her husband – a math teacher – her two young adult sons and her mother-in-law, with whom she’s particularly close. She also takes breaks at a family cabin in Kananaskis. And her late mother’s experience – dying four years ago from uterine cancer with her pain not managed well – spurs her on to make a difference for others.

Advances in pain management continue. There is a trial currently taking place at the Tom Baker involving tetrodotoxin, the neurotoxin in puffer fish, that holds promise as a painkiller. But in the meantime, it’s the people like Lee at places like the Supportive Oncology Clinic in Calgary who are making a difference.

“We are here for the patients – from the time of diagnosis, through treatment and, if necessary, recurrence,” Lee says. “We’re here to support their changing needs through their cancer journey, help them live longer and have a better quality of life.”

Careful Listener

During the telephone intake process, Renée Lee, manager of Supportive Oncology Clinic at the Tom Baker Cancer Centre asks patients questions about pain and other aspects of the cancer experience. She uses the result to arrive at a personalized plan to help patients cope and thrive.

She might ask:

  • How long have you had the pain?
  • Has it gotten worse and, if so, when?
  • Can you rate it on a scale from one to 10 (one being mild and 10 being severe)?
  • What medications are you currently on?
  • What other treatments have you tried?
  • What other symptoms are you experiencing, i.e. fatigue, nausea?
  • What is a typical day like?
  • Do you get out of the house?
  • Are you sleeping at night?
  • How and what are you eating?
  • Do you have support at home?
  • Do you sometimes feel depressed?