Our Approach & Expertise

Pictured: Nessa Coyle & Paul Glare

Nurse practitioner Nessa Coyle (left) and Paul Glare, Chief of the Palliative Medicine Service, work with a multidisciplinary team to relieve patients’ pain and discomfort at all stages of treatment.

Memorial Sloan Kettering has long recognized the importance of palliative care and the management of pain in cancer treatment and has been at the forefront of preventing and treating cancer-related distress for decades. In 1981, Memorial Sloan Kettering became the first cancer hospital to create a Palliative Medicine Service. Today the service, led by Paul Glare, continues to work to palliate, or relieve, any pain and discomfort that may be experienced by patients of Memorial Sloan Kettering.

Team Approach to Palliative Care

The Palliative Medicine Service incorporates the principles of palliative care into the treatment of all patients with cancer from the time of diagnosis, not only in the setting of advanced or terminal disease. Members of the service work alongside the oncologists who are treating the cancer, seeking to ease distress while remaining mindful of patient and family needs, values, beliefs, and culture.

To provide the best palliative care possible, the service may call on individuals from specialties such as interventional/anesthesia pain management, rehabilitation medicine, psychiatry and behavioral science, integrative medicine, chaplaincy, social work, pharmacy, wound care, radiation oncology, and neurology. This interdisciplinary approach allows the Palliative Medicine Service to provide care that improves quality of life for patients as well as their families.

Leadership in Pain Management

Memorial Sloan Kettering was the first cancer center in the United States to have an interdisciplinary service devoted specifically to treating pain in cancer patients. Neurologist Kathleen Foley and her colleagues in the departments of Neurology and Pharmacology at Memorial Sloan Kettering and Weill Cornell Medical Center performed groundbreaking scientific research that greatly advanced the science of pain medicine and established pain management as a priority in the delivery of comprehensive cancer care.

A guiding principle at Memorial Sloan Kettering Cancer Center is that access to pain relief is a basic human right. Fortunately, pain related to cancer can be managed effectively in most patients. Pain management is one component of a broad, symptom-management approach for patients at every stage of treatment and includes the following:

  • Constant Pain Monitoring — Memorial Sloan Kettering nurses are trained in pain assessment and pain management. Inpatients are asked every four hours whether they are experiencing pain, and they are encouraged to report pain to their nurse or doctor whenever it occurs. Patients rate the intensity on a scale of 0 to 10, and every effort is made to provide painkilling treatments as needed.
  • Help with Pain Care at Home — Because hospital stays are often short, patients treated for cancer often experience pain once they’ve returned home. Memorial Sloan Kettering’s Pain and Palliative Care Service outpatient clinics and Supportive Care Program help patients, caregivers, local clinicians, and community pharmacists control pain that extends beyond the hospital stay.

Over the past three decades, Memorial Sloan Kettering staff have led the development of international guidelines for cancer pain management based on rigorous laboratory and clinical research. Our doctors helped develop the World Health Organization’s three-step approach to cancer pain management and the US Agency for Health Care Policy and Research clinical practice guidelines for the treatment of cancer pain, both of which have been validated by large, randomized clinical studies.

The Supportive Care Program provides support to patients who require pain management that extends beyond the hospital stay. The program’s acute pain nurses, or APNs, with support from the Palliative Medicine Service interdisciplinary team, consult with patients, caregivers, local clinicians, and community pharmacists, offering their expertise in reducing pain and controlling other symptoms experienced by patients after leaving the hospital.

Investigational Approaches

Memorial Sloan Kettering continues to make significant contributions to the understanding and effective treatment of pain, including in the following key areas of research:

  • identifying pain syndromes specific to cancer patients
  • tracing the neurologic mechanisms of pain, and the relationship of social and psychological factors with pain
  • establishing accurate methods of pain assessment
  • correlating levels of treatment with the pain relief they provide