Dr. Neal Slatkin Named One of America's Top Doctors for Cancer Pain

Fran Lowry

February 28, 2011

February 28, 2011 — Neal E. Slatkin, MD, chief medical officer of the Hospice of the Valley, in San Jose, California, has been named one of America's top doctors in pain medicine by Castle Connolly, a company founded in 1991 to help consumers find the best healthcare, in their 9th list of America's Top Doctors.

Dr. Slatkin received the honor thanks to his peers, who voted him one of America's top docs in recognition of his work in palliative care and cancer pain.

He has been named to this elite group before. For 3 years running — 2007, 2008, and 2009 — he was named Top Cancer Doctor for his treatment of pain specifically related to cancer; in 2007 and 2010, he was named Top Doctor in Pain Medicine.

Always Interested in Pain

Dr. Neal Slatkin

Dr. Slatkin is board certified in neurology and psychiatry, pain management, and hospice and palliative medicine.

Before joining Hospice of the Valley in September 2009, he was director of supportive care, pain, and palliative medicine, and a professor in the Department of Neurology at the City of Hope Cancer Center in Duarte, California.

Dr. Slatkin, who was born and raised in Brooklyn, New York, attended the State University of New York at Buffalo for his undergraduate degree and received his medical degree from the State University of New York at Stony Brook. He completed a fellowship in neuro-oncology at Memorial Sloan-Kettering Cancer Center in New York City, where his interest in pain, which has been with him since his days as a resident, intensified.

"I couldn't help but develop an interest, because [Kathleen M. Foley, MD, attending neurologist in the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center and chair of the International Association of Hospice and Palliative Care], was the director of the pain program. In her fellowship class, at the same time I was there, was Russell Portenoy, MD [now chair of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York City], and Mitchell Max, MD [director of the Molecular Epidemiology of Pain Program at the University of Pittsburgh Center for Pain Research in Pennsylvania at the time of his untimely death in 2008]. I was surrounded by people who went on to make a name for themselves in the field, so it was hard not to become interested in pain," he said.

The treatment of cancer pain has been a neglected area of pain management for a number of reasons, Dr. Slatkin told Medscape Medical News. For one thing, few doctors who specialize in the treatment of pain have access to cancer patients. For another, the treatment of pain is not particularly lucrative.

The treatment of pain is not — shall we say — 'procedurally rich.'

"Oncologists tend not to refer their patients to pain specialists. And the treatment of pain is not — shall we say — 'procedurally rich'. It is extremely time consuming. You are dealing not only with the very obvious pain problems these folks have, but also with myriad other symptoms — existential anxiety, constipation, sleeplessness, weight loss, orthostatic hypotension and dizziness, fatigue, nausea, and vomiting. To get the pain under control, you have to deal effectively with these other symptoms. In reality, the treatment of pain in this patient population becomes true palliative care," he said.

When Dr. Slatkin was at City of Hope, patients or their families would often say they wished they had found out about him sooner. "That was always very painful to hear because it said to me that they had suffered needlessly," he said.

Effective pain control is a persistent problem in oncology. "The oncologist's primary focus is not on the patient's symptoms, but on the cure. We haven't elevated the need for effective pain management to the level where it is recognized that expertise is truly needed," said Dr. Slatkin.

There is an imbalance in the sense that we fail to recognize that pain can be life threatening.

"For example, all oncologists are trained as internists, so all have been trained in cardiology. If their patient develops cardiac problems, the oncologist does not hesitate to refer that patient to a cardiologist. But if a patient reports a pain problem, since pain isn't considered life threatening, the patient is not referred to a comparable expert in pain management. I think there is an imbalance in the sense that we fail to recognize that pain can be life threatening," Dr. Slatkin said.

Patients might prematurely abandon treatment because of the symptoms they experience. In addition, pain — both acute and chronic — can result in immune suppression.

"Getting people's pain under effective control can only aid the efforts to control the patient's tumor," Dr. Slatkin said.

Dr. Slatkin has been a palliative care specialist now for about 16 years. He admits that it can be stressful.

It is hard not to be somewhat despairing at times.

"You are dealing with horrible things that happen to sometimes truly wonderful people, and it is hard not to be somewhat despairing at times. Our treatments, let's face it, are imperfect," he said. This realistic view helps him keep his equilibrium and avoid burnout.

"Ultimately, you are going to lose out to some illness. We all die. There is that famous Woody Allen quote: 'I don't want to gain immortality through my work. I want to gain immortality through not dying.' But that's not in the cards for any of us. We are always going to lose out in some fashion," Dr. Slatkin said.

He calls palliative care "good, honest work."

"We are very straightforward with our patients. It would be more difficult to work in an area such as oncology if you constantly felt the need to hold out the hope of cure or major life prolongation when, in your heart and intellectually, you know that it is not going to happen," he said.

"If you felt duty bound to hold out that strong measure of hope to people, it would lead to more burnout. Frankly, if you were so self-deceiving as to think that you were going to triumph the vast majority of time over cancer, then that would be despairing," he said.

"The City of Hope used to have a tag line on its marketing campaign that said 'City of Hope, where the power of knowledge saves lives'," Dr. Slatkin recalled. "It sounds good."

But, he added, "I didn't become exactly popular when I asked: 'How does the power of knowledge serve the 86% of souls who cross our threshold whose lives we don't save?' But that is true. It's something we don't talk about. It's that dirty little secret."

Fine Leadership

Sally Adelus, president and chief executive officer of Hospice of the Valley, told Medscape Medical News that she was very pleased when Dr. Slatkin came on board nearly 2 years ago.

"I had known of Dr. Slatkin's expertise in pain management and cancer care, not only in our local community, but nationally. When we were looking to recruit a chief medical officer, it was absolutely essential, because of the emerging field of palliative care, that somebody of his stature be able to join us," she said.

He's very special.

"He's got such a fine leadership style," Ms. Adelus continued. "For a physician to not only have the expertise in research, but to couple it with such fine patient care delivery, which is exactly what he does, is very special. You do not get that combination very often. That is what's unique about Neal. He's very special."

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