What Is Palliative Care?
by Paul Glare, MD
When a person is diagnosed with cancer, treatment that will cure – or at least control – the disease and prolong survival is obviously the number one priority. However, at the same time, most people diagnosed with cancer will have several other needs. They may be in pain, feel nauseous, or be short of breath. They are likely to be anxious, angry, or depressed. They may need to start thinking about their goals and priorities for the remainder of their life, especially if the cancer is advanced. And their family and friends may need support.
Cancer treatment can go on for years, and these problems can develop at any point during the illness. These issues may be caused by the disease, or they may occur as a side effect of treatment. Addressing these multiple issues in a comprehensive and coordinated way is called palliative care. It is important to understand that palliative care is not the same as hospice; in fact, hospice is a special type of palliative care that is only offered to people who have a prognosis of less than six months and wish to forgo further active treatment.
Oncologists or primary care physicians can provide most palliative care, especially when the issues are not too complicated or time intensive. Palliative care is administered in a hospital or at the doctor’s clinic, and it is generally covered by insurance. In most cases, palliative care is provided concurrently with cancer treatment, and the aim is to help people cope better with their treatment by maximizing their comfort, reducing their distress, and supporting family caregivers. In fact, a recent study published in the New England Journal of Medicine showed that palliative care prolonged survival in people with lung cancer.
It is important to understand that palliative care is not the same as hospice.
To provide optimal palliative care, however, the oncologist may need to involve other members of a multidisciplinary team, including nurses, psychologists, social workers, nutritionists, physical therapists, and chaplains, to develop a coordinated care plan. When the issues are complicated, a palliative care specialist may need to be called in. Most comprehensive cancer centers and almost 60 percent of American hospitals have a specialist palliative care service. Palliative care is part of acute medical care and is coverred by most insurance.
Children can also receive palliative care. In these situations, parents usually work with the healthcare team to help their children manage symptoms so they can feel as comfortable as possible. Members of the family, including other children, may also receive counseling as part of the palliative care plan to help them cope with the situation.
People often don’t want to ask for help with pain or other palliative care issues because they want to be a “good patient” and do not wish to distract their oncologist from the main objective of curing their cancer. However, having all your needs addressed is an important aspect of comprehensive cancer care. To reflect this, for example, beginning in February, it will be mandatory for physicians in New York to discuss palliative care options with their patients. Don’t be afraid to ask for a referral to a palliative care specialist if your oncologist is unable to meet your or your family’s palliative care needs.
You should seek out palliative care if
- you have pain or other symptoms that are not being adequately controlled by your present medicines;
- you have a history of allergies to pain medicines or other drugs used to control symptoms;
- you have a history of depression or other psychiatric illness;
- you or your family is very distressed by your illness;
- you have other serious illnesses, such as heart failure, COPD, AIDS, or Alzheimer’s disease;
- you have family or caregiver limitations;
- there is conflict in your family regarding the goals of care; or
- you are having a spiritual or existential crisis.
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Dr. Paul Glare is chief of the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center in New York.
This article was published in Coping® with Cancer magazine, September/October 2010.