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Palliative Care

It’s not just for end of life anymore

by Ana Maria Lopez, MD, MPH, FACP, and Charlotte Alster

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As the number of cancer survivors grows, many people have come to consider cancer to be a chronic condition. Until recently, most healthcare professionals have taken the view that the goal of cancer treatment should be curative. Recent developments in cancer treatment outcomes have resulted in a shift in this approach.

Unlike infectious diseases, such as strep throat, that can be cured, many diseases, like diabetes and high blood pressure, are not curable but may be controllable. As cancer outcomes have improved, cancer, too, may be considered a chronic disease. In other words, many individuals currently living with metastatic cancer may experience disease symptoms that are controllable, although the disease itself may not be curable. This is where palliative and supportive care comes in.

The concept of palliative care was introduced in the United States in the 1970s. At that time, palliative care was intimately connected to hospice care with its focus on symptom management at the end of life. Today, palliative care has expanded to address the symptom management needs of all people with cancer – even those receiving curative treatment in the acute setting.

What is palliative and supportive care?
Palliative and supportive care services support curative care by ameliorating the symptoms that treatment may cause. As a clinical service, palliative and supportive care programs provide comprehensive care in symptom management, including psychological support, for people with chronic, potentially terminal diseases such as cancer and HIV. These symptoms may include pain, nausea, fatigue, depression, anxiety, difficulty breathing, and loss of appetite. The alleviation of these symptoms facilitates cancer recovery.

Today, palliative care has expanded to address the symptom management needs of all people with cancer – even those receiving curative treatment in the acute setting.

Author of Article photo

Dr. Ana Maria Lopez

Why is palliative and supportive care important?
Chronic diseases are complex and often coexist with other illnesses, complicating treatment options. Palliative and supportive care services provide a multidisciplinary framework of physicians, nurses, social workers, chaplains, clinical nurse specialists, pharmacists, and nutrition specialists with whom you and your family can discuss treatment options and goals in order to help you determine your own best possible treatment path.

Author of Article photo

Charlotte Alster

Team coordination and continuity of care is the hallmark of palliative and supportive care services. Coordination of care in the inpatient or outpatient setting is often impeded by a lack of communication between providers. Miscommunication promotes medical errors and dangerous outcomes by leaving an individual with a myriad of differing prescriptions and conflicting advice. Palliative and supportive care services usually begin formulating a discharge plan at the time of admission. The palliative and supportive care team works together to provide you and your family with a coherent plan to address treatment goals, minimize confusion, and facilitate communication. The team considers social, family, transportation, medical, and equipment needs in order to produce a sustainable discharge plan to educate you and your caregivers while instilling confidence in your ability to manage your illness and symptoms.

Where can I find palliative and supportive care services in my area?
Since palliative and supportive care services have traditionally been linked to hospice care, they have developed alongside hospice services and inpatient hospital care. As cancer care has begun to shift to the chronic disease care model, outpatient cancer clinics have begun to link with hospital programs or to develop their own outpatient palliative and supportive care services.

These shifts are necessary in order to proactively meet the changing needs of the growing cancer population. Palliative and supportive care services are as essential to cancer care as chemotherapy to help you live life to the fullest.

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Dr. Ana Maria Lopez is associate professor of Clinical Medicine and Pathology and medical director of the Arizona Telemedicine Program at the Arizona Cancer Center in Tucson, AZ. Charlotte Alster is a premed student at Carleton College and an Elizabeth Blackwell Fellow in Health Disparities in Women’s Health at the University of Arizona.

To find out more about palliative and supportive care services, talk to your doctor or visit www.capc.org and click on the program directory to find palliative and supportive care services in your area.

This article was published in Coping® with Cancer magazine, May/June 2009.

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