Recently, we had a head and neck cancer patient with over a 12-year history of opiate use for chronic back pain, and severe drug-seeking behavior. His treatment regimen was explained to him and we stressed the need for him to be compliant -- but this was easier said than done.
Because this patient had an extensive history of narcotic use, he was referred to a pain management specialist. He was verbally agreeable to this plan, and did indeed go for his pain management treatment. However, when he came for his first chemotherapy treatment appointment, he was not able to sit still and was very disruptive -- we could not safely provide treatment.
Discussion was held regarding nursing home placement to help with symptom management and compliance during treatment. He was agreeable and arrangements were made. He was able to begin treatment, but several weeks later, he started leaving the nursing home on his own to do who knows what, and would return back to the facility whenever he felt like it.
Arrangements were then made for the patient to transfer to a facility that was better suited for his psychological needs, but unfortunately, he disappeared on the day the transfer was scheduled, and was brought in the next day by the paramedics after being found wandering the streets and muttering unintelligibly.
He continued to follow a downward course with a very poor outcome. I know, ultimately, that patients are responsible for their own compliance with cancer treatment, but I often wonder if we could have done anything differently to achieve a better outcome.
Have any of you ever had an experience with a patient such as this? Any suggestions as to other interventions you have found beneficial?