1. 3. How do you intend to resolve the issue?

2. Approach to the patient Assure patient’s safety! Talk the patient out of committing suicide – Remind him that he is not alone in this situation and reassure him of the love and support of his loved ones. – Listen to what the patient has to say – Symptomatic treatment (pain, fatigue, depression) – Support group for cancer patients – Advice him to reconnect with God – Refer to psychologist/psychiatrist

3. http://www.maithrikochi.org/suicide_facts.htm#RightApproach

4. Management of Lung Cancer with Bone Metastasis

5. TREATMENT OBJECTIVES The main ones are to: – relieve pain – improve quality of life – make them more ambulatory – prolong pain-free survival, and, – if possible, prolong their overall survival. The primary goal of therapy is to : - eradicate as many tumor cells in the bone as possible.

6. Management of Lung Cancer with Bone Metastasis No role of curative surgery Treatment for bone metastasis is normally palliative Assess risk of pathological fracture Lesions representing risk for fracture- treated with radiation or by appropriate chemotherapy Zoledronic acid- bisphosphonate used to treat bone metastases from lung cancer Radiation therapy Radiofrequency ablation

7. External Beam Radiation Radiation therapy is a very effective way to treat patients with metastatic disease to the bone. Pain relief: – Complete in 50% patients – Partial in 30-40% patients Onset of pain relief: a few days to 4 weeks Duration: 3-6 months >50 % of patients with some pain relief have re-emergence of pre-treatment pain levels

8. Management of Lung Cancer with Bone Metastasis Lesions regarded as a risk for pathologic fracture managed: Surgically on an elective basis Non-surgically via manual stabilization Goals of surgery: to preserve stability & function of musculoskeletal system as well as alleviate pain Emergency surgery done for spinal metastasis to preserve neurological function