During our medical training, we were often reminded that our purpose is not just to take care of a disease, but rather, to take care of the person with that disease. We learned that a patient's physical condition represents only one aspect of that disease and that patient. We also learned to listen to patients and understand their illness within the context of their lives.
Pancreatic cancer puts this notion to its greatest test. Because of limitations that exist in so many crucial aspects of this disease, from early diagnosis, to accurate noninvasive staging, to effective treatment, we are faced with the difficult task of offering primarily palliative care to individuals with an advanced stage of a highly malignant, symptomatic disease. Because of the progressive nature of advanced pancreatic cancer, palliative measures must be continually reassessed and adjusted to meet the changing needs of the patient. These needs place a great burden on the patient, patient's family, and health-care system. Aside from efforts directed at control of the tumor itself, adequate attention must be given to attempts to reduce pain, control nausea and vomiting, optimize nutrition, recognize and treat depression, promote patient involvement in disease management, identify and compensate for functional disability, and facilitate access to support systems for social and spiritual needs.
This issue of ONCOLOGY focuses on the multifaceted care of patients with pancreatic cancer. We have endeavored to provide viewpoints from a wide array of health-care professionals who may be involved in the care of these patients. In addition to insights from medical, surgical, and radiation oncologists, we are fortunate to have the perspectives of a clinical nurse specialist who works on a gastrointestinal surgery service (Ms. JoAnn Coleman), a nutritionist (Dr. Faith Ottery), a psychologist who works exclusively with cancer patients (Dr. Steven Passik), an oncology social worker based in a community setting (Ms. Victoria Kennedy), a registered nurse and cancer survivor who promotes patient advocacy (Ms. Susan Leigh), a physician who heads a palliative care program (Dr. Declan Walsh), and the head of a hospital-based pastoral care program (Reverend George Handzo). The different backgrounds and training of these individuals provide each with a slightly different, but complementary, approach to the care of the person with pancreatic cancer. It is hoped that the information contained in this supplement can help health-care professionals identify and successfully address the many needs of our patients with pancreatic cancer and their families.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
