It has often been stated that although every patient with cancer cannot be cured, there is no patient for whom nothing can be done. Due to the many agents which are now available for keeping patients with cancer alive and comfortable for longer and longer periods of time it is becoming increasingly difficult to prognosticate the life span for any individual.

Cancer is only one of many diseases which creates problems when the patient reaches the stage of chronic disability; but somehow cancer often seems to bring special problems-social, emotional, physical, and economic. The extent of the problem depends on many factors in addition to the emotional and psychological variations which are an integral part of each person. How much the patient knows about the condition he has, how much his diagnosis has been discussed with him, his experiences with others who have had cancer, and his family responsibilities-all of these and many other factors enter into the patient's response to his illness. It requires the cooperative effort of many people-physician, nurse, family, and friends to help with the adjustments which must inevitably be made.

The patient also responds to the attitude of the nurse or the person providing the physical care which he requires. It can be quite time consuming to give all of the care which the patient needs to make him comfortable. Any hint of help which is grudgingly given evokes an emotional response in the patient. He is quick to sense resentment of the time required to make him comfortable or to listen to his complaints.

Those who give care to the patient are affected by many of the same factors as the patient himself. They, too, have feelings about cancer, and have had experiences which color their reactions. Even professional personnel often find it difficult to gain the same job satisfaction in providing care for the patient who has a long-term incurable illness as they do in giving care to patients who fully recover from short-term illnesses.

It often requires a readjustment of the nurse's goals to achieve other satisfactions; for example, in planning ways to make the patient more comfortable and in some small way contributing to his peace of mind. Often she prefers working with patients who present less complicated problems; there is a tendency to shy away from situations which are difficult. Yet there are multiple problems in relation to care of the patient with advanced disease and many of these can be solved by the ingenious and understanding nurse who has insight and the will to spend time teaching the patient and others in the family.

Some of these cluster around certain specific areas. A few will be discussed:

1. Ambulation

Patients should be kept active for as long a period of time as possible. Those who cannot walk can often use a wheelchair or walker and continue to perform small but useful tasks around the house. Increased bone destruction, thrombophlebitis, and hypercalcemia may result from prolonged bed rest. The patient should be encouraged to ambulate frequently even though he may have to return to bed for frequent rest periods.

2. Recreation

It is essential that the patient do something in the way of diversion. Radio and television are useful in this respect but it is also helpful if the patient can pursue some hobby he has had in the past. If not, some patients can be introduced to new hobbies which are within the scope of their interest and abilities. However, this is not meaningful to all patients, and should not be forced upon the unwilling. As said before many patients prefer to help with household tasks. Many times there are certain community organizations or clubs which provide recreational service and activities.

The nurse needs to watch for symptoms of tension in family members, especially in the person who is most involved in giving care to the patient. The family may need encouragement to take time for rest periods and outside recreation, especially when the patient remains ill for a long period of time.

3. Skin Care

The skin must have meticulous care especially in areas subject to pressure. Bony prominences should be checked frequently, especially in cachectic patients. Alcohol has a tendency to be drying and should be used with caution. Many newer rubbing compounds with a cream base are available. Bed patients should be turned frequently and back rubs may help prevent decubitus ulcers. However, back rubs or massage may be contraindicated for patients with skeletal metastases. Prompt attention is required to prevent subsequent infection whenever a decubitus appears. Recent reports on the use of granulated sugar have been interesting. In one hospital study, wounds were cleaned with hydrogen peroxide, the cavity filled with granulated sugar, and a dressing applied. In the same hospital 50 percent glucose was also used, in the form of wet packs. In this procedure the wound was cleansed with hydrogen peroxide, then packed with gauze which was saturated with the glucose solution. Dressings were changed several times a day. A more recent article discusses the use of aeroplast spray (see bibliography).

The physician should specify the treatment whenever the skin has been broken. Air mattresses are helpful but rather expensive.

4. Relief of Pain

Misconceptions about cancer include the erroneous idea that cancer is always painful. Actually cancer in itself is not a painful disease for the majority of patients except as obstruction or bone and nerve involvement occur. Open or infected wounds may be painful, and because of this, palliative treatment is often employed to eliminate such lesions (for instance, large fulminating cancers of the breast).

A great deal of the pain and anxiety associated with cancer can be relieved by the use of tranquilizing agents, sedatives, and aspirin. A distinction should be drawn between the need for medication to induce sleep and that needed to relieve pain. Aspirin is remarkably effective in reducing pain as are combinations of aspirin and other drugs. Narcotics are usually reserved until late in the patient's illness when nothing else is effective. Most physicians prefer starting their patients on oral narcotics.

Once narcotics are started it is essential that those responsible for the patient be guided in dispensing relief of pain. This involves exercising judgment about how much actual pain the patient is having and how much his anxiety or depression are being expressed in terms of pain perception. Under no circumstances should the patient control his own intake by specifying the time he is to be given the drug. This may initiate a practice which will result in addiction and subsequent distress for everyone concerned.

The use of other nursing measures to promote comfort-back rubs, mild sedation, listening with understanding can sometimes lessen the need for narcotics. In most instances the psychological support the patient receives has a direct bearing on his need for narcotics.

This in no way is to infer that narcotics ordered by the physician should be withheld from those who need them. It is, rather, a plea for judicious evaluation of the patient's discomfort at each given point of time in his illness.

There are other measures for the relief of intractable pain; some are relatively simple and others are quite complicated. Alcohol injections, nerve blocks with phenol or alcohol or neurological procedures (as cordotomy or rhizotomy). Occasionally hypnosis has been successfully employed.