404 Schedule with Abstracts Vol. 39 No. 2 February 2010

including the art therapist and psychologist,worked closely with the family to assist them dur-ing their time on the unit. However, due to the na-ture of the requests, the staff was unable to meetall of their needs, leading to frustration on thesides of both parties.

DomainsStructure and Processes of Care; Psychologicaland Psychiatric Aspects of Care; Social Aspectsof Care; and Ethical and Legal Aspects of Care

How Do I Tell My Children?Kathleen Doyle, MD, Harvard, Jamaica Plain, MA.(Doyle has disclosed no relevant financialrelationships.)

Objectives1. Identify tools to use when discussing cancer

and death with children.2. Discuss ways to approach parents about dis-

cussing cancer with their children.Although we guide our patients and those at thebedside through the dying process, there are somany others affected by the death, including chil-dren who cannot be present. ES was a 35-year-oldMuslim woman from Kuwait with invasive ductalcell carcinoma with metastases to the liver, diag-nosed in 2006 during her pregnancy with herfifth child. She underwent chemotherapy andsubsequently delivered a healthy child, but waslater found to have bone metastases. ES under-went radiation and chemotherapy in Kuwait,and did well until February 2009 when she devel-oped lytic spine lesions and a growing liver le-sion. She came to the United States for careand began Xeloda therapy. After 9 months, shepresented with evidence of further disease pro-gression, liver failure, increasing abdominalpain, and nausea. ES had not seen her childrenin 5 months and missed them terribly but feltthat she was striving for a cure for them. Shewas discharged home with good symptom controlon low-dose morphine and haldol, but one weeklater was admitted to the ICU with worseningliver failure and sepsis. ES was lethargic, but wasable to say that she wanted to see her children.At that time her husband wanted to take herhome to Kuwait but she wasn’t stable for transfer.Despite antibiotics, pressors, and intravenousfluids (IVF), ES declined rapidly and passedaway within hours, not having seen her children.In addition to the loss of his wife, her husbandstill carried the burden of telling his five childrenabout the death of their mother. We will discuss

how the palliative care team can help a fatherlearn to tell the children their mother’s story, in-cluding her death, and how that can be a healingexperience for them all.

DomainsStructure and Processes of Care; Psychologicaland Psychiatric Aspects of Care; and Social As-pects of Care

7e8 pmManagement of Refractory Pain inPalliative Care (430)Russell K. Portenoy, MD, Beth Israel MedicalCenter, New York, NY. Judith Paice, PhDRN, Northwestern University, Chicago, IL.(All speakers have disclosed no relevant finan-cial relationships with the following exceptions:Portenoy has an active consulting agreementfor the past three years with Ameritox, Cepha-lon, Grupo Ferrer, King Pharmaceuticals, Nicox,Pfizer, Shire Pharmaceuticals, Solvay, Wyeth, Xe-non, and educational/research grants to the de-partment of pain medicine and palliative care atArchimedes Pharmaceuticals, Baxter HealthcareCorporation, Calloway Labs, Cephalon, EndoPharmaceuticals, Flamek Corporation, Fralex,GW Pharmaceuticals, King Pharma, Pfizer, Inc.,Purdue, Tempur-Pedic Corporation, United Bio-Source Corp., Wyeth, Paice will discuss off-labeluse.)

Objectives1. Review best practices for the pharmacological

management of severe cancer-related pain inpatients who do not respond adequately tofirst-line opioid-based pharmacotherapy.

2. Review the role of interventions in the man-agement of cancer pain that has been poorlyresponsive to opioid therapy.

3. Review the challenges posed by end-of-lifecare in cancer patients with pain that hasbeen poorly responsive to opioid therapy.

This interactive, case-based teaching forum willfocus on the management of patients with severepain that is poorly responsive to first-line, rou-tine opioid pharmacotherapy. The case involvesa patient with non-small cell lung cancer who de-velops a chest-wall pain syndrome and then bonepain and continues to experience severe paindespite systemic opioid treatment. Best practiceincludes a comprehensive assessment and con-sideration of a variety of strategies for the pain,including the use of systemic adjuvant analgesics