It is not unusual for patients with head and neck cancer (HNC) to suffer from both tumor and treatment-related pain that is difficult to alleviate despite individualized pharmacological treatment. The presence of concomitant various dimensions of pain in patients during the often difficult period following radiotherapy (RT) has not been elucidated. Several aspects concerning the importance of relatives for HNC patients have been addressed. However, little attention has been given to how relatives perceive patients with HNC pain and it is important to further elucidate this sparsely studied topic. Knowledge about health-related quality of life (HR-QoL) in this patient group during early RT is limited and needs to be assessed in relation to diagnosis and treatment. Self-care (SC) refers to what patients do on their own to achieve, maintain, and promote optimal health and may help reduce pain for several pain conditions. The impact of patient education and SC on pain and other common HNC symptoms need further clarification. The aims of this thesis were: to describe experiences and perceptions of pain in patients with HNC shortly after RTto describe how relatives perceived the patient’s situation, especially concerning pain, and how they experienced their own situationto identify factors that impact HR-QoL during early RTto develop effective pain management strategies, maintain activities of daily living, and promote HR-QoL in patients with HNC undergoing RT using patient education and SC instruction. In paper I patients with HNC described existential pain – expressed as fear of death, meaninglessness and guilt – already during and shortly after RT. Physical pain, psychological distress and social withdrawal played a significant role. Patients with HNC who were treated with RT should also proactively be offered treatment for the various dimensions of pain. In paper II relatives described their mental stress in response to a challenging situation that required their active support to help ease the patient's difficult condition. The interviews with relatives also revealed a lack of personal knowledge and frustration over the inability to participate in patient care, as well as inadequate support from the healthcare system. Early interventions from the healthcare system on behalf of the relatives may be necessary to meet these needs. In Paper III regression models revealed that pain intensity and symptoms of depression adversely affected HR-QoL in patients with HNC during early RT. Customized prehabilitation programs aimed at preventing pain and symptoms of depression could help preserve good HR-QoL. Paper IV assessed individual patient education and SC initiatives that resulted in a tendency for lower pain intensity during a portion of RT. One way to potentially enhance the benefits of education and SC could be to improve for example patient motivation and self-efficacy, as well as to optimize supportive efforts from caregivers. In conclusion, by identifying factors that can impact HR-QoL and evaluating the effect of patient education and SC, this thesis contributes to knowledge on perceived pain and the patient’s situation during and shortly after RT in patients with HNC and their relatives. This thesis points to the need for evaluation and further development of patient education and effective SC strategies for pain in patients with HNC undergoing RT, as well as for development and evaluation of support strategies for patients with pain and their families during and after RT.

It is not unusual for patients with head and neck cancer (HNC) to suffer from both tumor and treatment-related pain that is difficult to alleviate despite individualized pharmacological treatment. The presence of concomitant various dimensions of pain in patients during the often difficult period following radiotherapy (RT) has not been elucidated. Several aspects concerning the importance of relatives for HNC patients have been addressed. However, little attention has been given to how relatives perceive patients with HNC pain and it is important to further elucidate this sparsely studied topic. Knowledge about health-related quality of life (HR-QoL) in this patient group during early RT is limited and needs to be assessed in relation to diagnosis and treatment. Self-care (SC) refers to what patients do on their own to achieve, maintain, and promote optimal health and may help reduce pain for several pain conditions. The impact of patient education and SC on pain and other common HNC symptoms need further clarification. The aims of this thesis were: to describe experiences and perceptions of pain in patients with HNC shortly after RT to describe how relatives perceived the patient’s situation, especially concerning pain, and how they experienced their own situation to identify factors that impact HR-QoL during early RT to develop effective pain management strategies, maintain activities of daily living, and promote HR-QoL in patients with HNC undergoing RT using patient education and SC instruction. In paper I patients with HNC described existential pain – expressed as fear of death, meaninglessness and guilt – already during and shortly after RT. Physical pain, psychological distress and social withdrawal played a significant role. Patients with HNC who were treated with RT should also proactively be offered treatment for the various dimensions of pain. In paper II relatives described their mental stress in response to a challenging situation that required their active support to help ease the patient's difficult condition. The interviews with relatives also revealed a lack of personal knowledge and frustration over the inability to participate in patient care, as well as inadequate support from the healthcare system. Early interventions from the healthcare system on behalf of the relatives may be necessary to meet these needs. In Paper III regression models revealed that pain intensity and symptoms of depression adversely affected HR-QoL in patients with HNC during early RT. Customized prehabilitation programs aimed at preventing pain and symptoms of depression could help preserve good HR-QoL. Paper IV assessed individual patient education and SC initiatives that resulted in a tendency for lower pain intensity during a portion of RT. One way to potentially enhance the benefits of education and SC could be to improve for example patient motivation and self-efficacy, as well as to optimize supportive efforts from caregivers. In conclusion, by identifying factors that can impact HR-QoL and evaluating the effect of patient education and SC, this thesis contributes to knowledge on perceived pain and the patient’s situation during and shortly after RT in patients with HNC and their relatives. This thesis points to the need for evaluation and further development of patient education and effective SC strategies for pain in patients with HNC undergoing RT, as well as for development and evaluation of support strategies for patients with pain and their families during and after RT.

Considers what can - and should - be done to comfort patients suffering from the distressing symptoms of advanced cancer. Prepared by nine renowned experts in oncology, neurology, pain management and nursing care, the book draws together the evidence and arguments needed to define clear lines of action, whether on the part of the medical and nursing professions or in the form of national legislation. Throughout, arguments for palliative care take their force from the magnitude of unrelieved suffering currently borne by the majority of terminally ill patients. Although methods for the relief of pain are emphasized, other physical, psychological, and spiritual needs for comfort are also included in the report's comprehensive recommendations. The concept of palliative care is explained in terms of its concern with quality of life and comfort before death, emphasis on the family as the unit of care, dependence on teamwork, and relationship to curative interventions. Subsequent sections concentrate on measures for the relief of pain and other physical symptoms, the psychosocial needs of the patient and family, and the need for spiritual comfort. A section devoted to ethics provides several important statements concerning the legal and ethical distinction between killing the pain and killing the patient, and the need to recognize the limits of medicine. ..". crammed with very valuable information ... an altogether excellent book..." - Family Practice ..". a comprehensive report on cancer pain relief and active supportive care ... a valuable reference for those specializing in cancer care and for the generalist caring for dying patients..." - Nursing and Health care WHO definition of palliative care

This sixth edition of the Oxford Textbook of Palliative Medicine takes us now into the third decade for this definitive award-winning textbook. It has been rigorously updated to offer a truly global perspective, highlighting the best current evidence-based practices, and collective wisdom from more than 200 experts around the world. This leading textbook covers all the new and emerging topics, updated and restructured to reflect major developments in the increasingly widespread acceptance of palliative medicine as a fundamental public health need. The sixth edition includes new sections devoted to family and caregiver issues, cardio-respiratory symptoms and disorders, and genitourinary symptoms and disorders. In addition, the multi-disciplinary nature of palliative care is emphasized throughout the textbook, covering areas from ethical and communication issues, the treatment of symptoms, and the management of pain. The Oxford Textbook of Palliative Medicine is a truly comprehensive text. No hospital, hospice, palliative care service, or medical library should be without this essential source of information. This sixth edition of the Oxford Textbook of Palliative Medicine is dedicated to the memory of Professor Kenneth Fearon husband of Professor Marie Fallon and a surgeon who became a world leader in the research and management of anorexia and cachexia. He modeled a work-life balance that is so critical in our field, with devotion to both his patients and his family.

This book is an introduction to cancer treatment, the basics of radio- and chemotherapy, drug actions, the eradication of cancer cells, and the origins and persistence of pharmacological and toxicological effects of drugs. It further provides ideas for research based on knowledge of cancer metastasis, invasive and molecular pathways, and diagnosis and treatment. Many of the adaptive features of cancer biology, clinical features, pathology and treatment are reviewed. In addition to introducing the major themes and theories, the book also advances the current discussion by moving beyond explanations for clinical implementation. Key Selling Features: Reviews basic cancer treatments Summarizes chemotherapies Discusses radiotherapies Examines pharmacological and toxicological approaches to treatment Introduces oncological drug development