The Fearful Process of Dying from Prostate Cancer

Many men tell me that they fear the process of dying—suffering and experiencing pain—more than they fear death itself.  While I am no fan of pain, as a medical oncologist I have managed hundreds of patients with terminal cancer.  I have learned that with good communication between patients and doctors in conjunction with expert medical management, pain can almost always be effectively controlled. 
However, when reviewing the results of a recent patient survey at a meeting sponsored by Bayer Pharmaceuticals with a number of patient advocates, healthcare experts, and other physicians, it became sadly apparent that many patients are not receiving expert treatment.

 The survey indicated that many men with advanced cancer are suffering needlessly, mostly due to a failure to establish good communication with their doctors. 
In this survey of 410 men with advanced prostate cancer, two-thirds of men elected to manage their pain simply by ignoring it!  One-third of all the men surveyed felt that acknowledging pain made them more fearful, raising anxiety about the possibility that their cancer is progressing.  A quarter of the men said, “It was difficult to talk about their pain,” relating that such discussions made them feel weak. 
In other words, these men are relying heavily upon a commonly used psychological defense mechanism called “denial.”  One thing I have learned from years of experience treating patients is that denial can be a wonderful way to endure hopeless circumstances.  Men who are in denial of their circumstances can be quite happy even when everyone around them knows that they are dying.

Denial, however, is a seriously detrimental situation if what is being denied, in this case pain, can be fixed or remedied.  The men who fail to discuss pain with their doctors because they are in denial potentially block their access to a solution for the pain problem. 
Using denial can effectively control pain for short periods of time; however, using it on an ongoing basis is psychologically exhausting.

 Also, while denial might work for the patient, it can’t fool their surrounding loved ones.  They see the effects of pain in the patient manifesting as fatigue, depression, inactivity, impatience, insomnia and hopelessness.  Ultimately, the caregivers who surround the patient empathize with the patient’s suffering and they themselves end up feeling the pain that the patient is denying.  
Cancer patients experience pain from multiple causes, not just their cancer.  Invariably, life itself is painful.  However, most types of cancer pain can be resolved.  The first step is to acknowledge its existence. The second step is to diagnose whether the pain is cancer-related.  In the prostate cancer world, cancer-related pain is usually the result of bone metastases.  Of course, not all bone pain is from cancer and not all bone metastases cause pain.  If a man has pain in one of his bones and a bone scan shows a metastatic lesion in the exact same area as where the pain is occurring, then the pain is probably cancer-related.

The third step, once it has been confirmed that the pain is cancer-related, is to undertake appropriate cancer-specific therapy.  Hormones, chemotherapy or injectable radiation with Xofigo are highly effective at controlling pain.  When initiating cancer-specific therapy, while waiting for the anticancer effects of the treatment to kick in, short term relief can usually be accomplished with analgesics.  
Someone has said, “Not knowing what to do is the worst kind of suffering.”  Helping men find a workable solution begins by establishing open lines of communication between the doctor and the patient.  Selecting optimal treatment depends on an accurate diagnosis of the patient’s status.  With the right information, doctors can select the correct treatment which leads to a quicker resolution of the pain for both the patient and the caregivers. 

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