Profile
Dr. Kathy Foley
Our medical advisor and member of the Rita Allen Foundation Scientific Advisory Committee, and Rita Allen Foundation Scholar.
Incumbent of The Society of Memorial Sloan-Kettering Cancer Center Chair in Pain Research and former Chief of the Pain and Palliative Care Service. A member of the Institute of Medicine of the National Academy of Sciences and Medical Director of the International Palliative Care Initiative at the Open Society Foundations.
As part of a series of profiles illuminating our Rita Allen Foundation Scholars, their careers, accomplishments and aspirations, Dr. Foley recently shared some of her thoughts with Rita Allen Foundation President and Chief Executive Officer Elizabeth Good Christopherson.
Ms. Christopherson: How did you begin your career and who were some of your mentors?
Dr. Foley: In the early 1970s, I trained at Memorial Sloan-Kettering Cancer Center and became chief resident in neurology both at Memorial Sloan-Kettering Cancer Center and at Cornell. In 1974, Dr. Jerry Posner [who then headed neurology at Memorial Sloan-Kettering Cancer Center] offered me a fellowship to study pain.
At the time, cancer patients were inadequately treated for pain. Medications were not given in anticipation of pain, as they are today.
Also at about that time, the modern pharmacology of treating pain was just beginning, with the new understanding that morphine-like receptors were present in the brain. At Memorial Sloan-Kettering Cancer Center, a medical pain clinic had started, and there was an informal pain consultation service. By 1981 we'd formalized a pain service as a designated service within the Department of Neurology.
I was given the task of bringing together the programs that worked on pain -- clinical analgesics, which was run by Memorial Sloan-Kettering Cancer Center physician Dr. Raymond Houde and nurse Ada Rogers; clinical pharmacology, which was directed by Dr. Charles Inturrisi, professor of pharmacology at Weill Cornell Medical College; and the clinical neurology program - and it was the first designated pain service in a cancer setting in the United States. Other physicians joined us, including [Memorial Sloan-Kettering Cancer Center neurologist] Dr. Gavril Pasternak, who was developing a laboratory to study opiate receptors in the brain. Working with Drs. Houde, Pasternak and Inturrisi, we developed a program at Memorial Sloan-Kettering Cancer Center that combined basic and clinical research, along with a training program. We also developed a supportive care program for patients with complicated pain and advanced cancer.
While I remained on staff at Memorial Sloan-Kettering Cancer Center, I gave up heading the Pain and Palliative Care Service in 1995 to devote more time to directing the Project on Death in America (PDIA). This 45 million dollar, nine-year project funded by [financier and philanthropist] George Soros had as its focus transforming the culture of death in America through initiatives in science, the humanities, education, and professional training.
PDIA recognized that we had to concentrate on the development of healthcare professional leaders and palliative care experts if we were going to be able to change the care of patients. We created leadership programs for physicians, nurses, and social workers. The scope of the projects PDIA funded was extraordinary. Palliative care is now recognized as a medical specialty and there are hospitals around the country, for instance, that received funding, which now have pain and palliative care services to both enhance patients' quality of life as well as provide end-of-life care. We also supported two Institute of Medicine (IOM) reports that identified problems in the profession and made recommendations for change. A report that I edited from the National Cancer Policy Board and the IOM, published in 2001, Improving Palliative Care for Cancer, is now the accepted standard for what the role of palliative care within cancer centers should be.
Ms. Christopherson: How hove these early years influenced your work today?
Dr. Foley: The Project on Death in America was catalytic for change in the United States. I now work to advance palliative care globally through the International Palliative Care Initiative also funded by the Soros Foundation. In this initiative we work with the World Health Organization (WHO), governments and national civil society groups to make pain relief and palliative care available in resource limited countries. For example, one of our grantees has worked with the government of Romania to change their narcotic drug laws to facilitate access to pain medication for cancer patients.
For many years, Memorial Sloan-Kettering Cancer Center was a WHO Collaborative Center in Cancer Pain Research. Now I currently serve on a WHO expert panel and serve as the chair of the group developing the palliative care standards for the WHO Cancer Control Program.
Ms. Christopherson: What changes have you witnessed in pain management and care over the past few decades?
Dr. Foley: In this country, there have been encouraging and significant changes. Bridging programs between palliative care and hospice care have been developed. Such bridging programs allow patients to receive palliative care concurrently with active therapy for cancer. That's a very big step, reflecting the recognition that palliative care with its focus on symptom management and psychosocial support should be available simultaneously to care for patients with complex chronic life-limiting illnesses throughout the continuum of their care.
In recent years, the most important change for patients is that pain is now recognized as the fifth vital sign, like blood pressure, and is monitored every day. In 1974, pain was not being monitored or treated. Now, patients who report pain can have a specific pain consultation, and medications will be ordered. These may vary from a patient-controlled analgesic pump to a wide range of different drugs. Pain patients are cared for in all settings including the hospital, the outpatient clinic and at home until their pain abates.
In general, there is a greater awareness on behalf of the public. Studies have shown that 44% of
American households are dealing with someone with chronic pain. This has helped move issues of pain management out of end-of-life care into the care of patients living with chronic disease.
Pain control, and the public's understanding of it, is becoming more sophisticated. But because the common drugs we use to treat pain are also drugs of abuse, fear of addiction and concern about the abuse of these medicines continue to thwart patients’ access to these effective and safe medications.
Ms. Christopherson: What do you think the future holds for pain management and palliative care?
Dr. Foley: The good news is that there is a growing interest in pain and palliative care research and in developing a research agenda. The public is increasingly sophisticated about the subject and are coming to these discussions with experiences of what they don't want to have happen to them when they have a pain experience or face a life-threatening medical situation. So, between burgeoning awareness and engaging a larger population to talk about the issues and not to view end-of-life care as a taboo topic, I think there is great reason for optimism.
Ms. Christopherson: In addition to your work in palliative care, you have been very helpful as the medical advisor to the Rita Allen Foundation and in facilitating the selection of Rita Allen Scholars, along with the other members of the Scientific Advisory Committee. What do you see as the most important strengths of the Rita Allen Scholars program?
Dr. Foley: We are so fortunate to have such brilliant and committed scientists aspire to be Rita Allen Foundation Scholars. Without a doubt, we see some of the best and brightest applicants in the world.
I would have to say our greatest strength is the flexibility the award affords each recipient. By design, we avoid onerous restrictions and allow each researcher a great deal of latitude in using the funds to explore new and innovative ideas. We provide them with the flexibility they need to follow wherever their research takes them and that is the greatest support we can give these young investigators.