In their own words: Seven advanced cancer patients describe their experience with pain and the use of opioid drugs.

Seven individuals living with advanced cancer, who were followed by a pain and palliative care service at an urban cancer center and had at least once expressed a desire for hastened death, describe how both pain and the use of opioid drugs affected their quality of life. Their description is part of a broader phenomenological inquiry on the experience of living with advanced cancer and how that experience affected attitudes towards life and death. Serial, "in-depth semi-structured" interviews were conducted (mean=3 interviews/patient). Themes that emerged in relation to pain and opioid use reflect struggle--with self, with God, and with desire to live and/or readiness to die. Recognizing the appraisal process that patients undertake regarding the cost/benefit of reporting pain and accepting opioids, as well as the impact on severe pain on desire for death, from the patients' own word, gives a framework for the clinician to intervene.