Vol. 45 No. 2 February 2013 407Schedule With Abstracts

This session will provide an orientation to thebigger picture trends in outpatient services, ex-amples of innovation, and emerging health sys-tem enablers and constraints. The sharedadvice and learning from the IPAL-OP AdvisoryBoard (10 palliative care leaders from leadingprograms) will be used to introduce participantsto the purpose and recommended use of thenew suite of tools.Participants will have time in small groups to dis-cuss their own outpatient challenges or aspira-tions and to develop priorities for using the toolsto support their own program development.

If It’s Not One Thing, It’s Another: The PainIs Gone but the Suffering Continues (SA521)Kathy Selvaggi, MD MS FAAHPM, Dana-FarberCancer Institute, Boston, MA. Katie Fitzgerald,MSN BSN APRN-BC, Dana-Faber Cancer Insti-tute, Boston, MA. Amanda Moment, MSWLICSW, Brigham and Women’s Hospital, Bos-ton, MA. Elizabeth Rickerson, MD, Brigham &Women’s Hospital/ Dana-Farber Cancer Insti-tute, Boston, MA. Rachelle Bernacki, MD MS,Dana-Farber Cancer Institute, Cambridge, MA.(All authors listed above had no relevant finan-cial relationships to disclose.)

Objectives1. Identify treatment strategies to control cancer

pain including the use of high dose opioids(including methadone patient controlled an-algesia [PCAs]), ketamine, interventionalprocedures, and dexmedetomidine and theirrisks.

2. Describe approaches to responding to exis-tential distress and learn ways to reframe thedistress to promote positive outcomes.

3. Demonstrate awareness and identify strategiesfor coping with caregiver burnout when man-aging complex patients at the end of life in-cluding care of ourselves, colleagues, andfamilies.

Systematic interdisciplinary assessment andtreatment strategies for cancer pain are well es-tablished, but the treatment of young adultswith cancer presents unique challenges. Youngadults with malignancies tend to have agg-ressive diseases with complex pain and psy-chosocial symptoms. Successful treatment ofcomplex cancer pain often unmasks severe psy-chological and existential distress for patients

and their families. The multidimensional suffer-ing that occurs in young adults and their fami-lies often requires a high functioninginterdisciplinary team with expertise in painand nonpain symptom management as well asthe ability to provide intense psychosocial sup-port and management.Through the use of a case presentation, wewill describe advanced therapies and the datafor supporting their use in treating cancerpain syndromes. The following therapies willbe discussed: methadone PCAs, ketamine infu-sions, intrathecal/epidural delivery systems,and dexmedetomidine. Selection of appropri-ate patients for these therapies and potentialside effects will be described and positiveand negative impacts of these aggressive painmanagement strategies on patients’ quality oflife will be explored, including the balancebetween pain control and potential side effects(myoclonus, dissociation, paralysis, anddelirium).Finally, we will explore ways to mitigate the anx-iety, fatigue, and burnout in caregivers that isthe norm when caring for these young, chal-lenging patients. Innovative strategies to man-age the needs of the healthcare team involvedwith young cancer patients at the end of lifewill be addressed, including approaches to de-crease burnout and improve sustainability. Al-though our case will discuss the experience ofa young adult suffering at the end of life, theinterventions and approaches outlined can beapplied to a variety of palliative care popula-tions.

Advance Care Planning With Children andAdolescents: It’s a Choice to Make! (SA522)Donna Zhukovsky, MD FACP FAAHPM, Univer-sity of Texas MD Anderson Cancer Center, Hous-ton, TX. Rhonda Robert, PhD, University ofTexas MD Anderson Cancer Center, Houston,TX. Marcia Levetown, MD FAAP FAAHPM,VITAS Innovative Hospice Care, Houston, TX.(All authors listed above had no relevant finan-cial relationships to disclose.)

Objectives1. Understand barriers and enablers relevant to

advance care planning (ACP) with seriously illchildren and their families.