Palliative Care

What is palliative care?

Palliative care is care given to recover patients' quality of life with a severe or life-threatening disease, such as cancer. Palliative care is access to care that addresses the person as a whole, not just their health. The purpose is to prevent or treat, as early as practicable, the symptoms and side effects of the disease and its treatment to supplement any relevant psychological, social, and spiritual difficulties. Palliative care is also termed comfort care, supportive care, and symptom management. Patients may accept palliative care in the hospital, an outpatient clinic, a long-term care facility, or at the house under the leadership of a physician.

Who gives palliative care?

Palliative care is generally provided by palliative care specialists and health care practitioners who have acquired special training or certification in palliative care. They implement holistic care to the patient and family or caregiver, concentrating on the physical, emotional, social, and spiritual problems cancer patients may encounter during the cancer experience.

Often, palliative care specialists serve as part of a multidisciplinary team that may involve doctors, nurses, registered dieticians, pharmacists, chaplains, psychologists, plus social workers. The palliative care team operates in union with your oncology care team to arrange your care and maintain the possible healthy quality of life for you.

Palliative care specialists also contribute caregiver support, aid communication among brothers of the health care team, and help with discussions focusing on care goals for the patient.

What issues are addressed in palliative care?

The physical and emotional outcomes of cancer and its treatment can vary significantly from person to person. Palliative care addresses a wide range of issues, tailoring its approach to each individual's specific needs. A palliative care expert considers the following aspects for each patient:

Physical: Common physical symptoms include pain, fatigue, loss of appetite, vomiting, nausea, insomnia, and shortness of breath.

Emotional and Coping: Palliative care professionals provide resources to help patients and families cope with the emotions that come with a cancer diagnosis and treatment. Anxiety, depression, and fear are some of the concerns that palliative care can address.

Spiritual: A cancer diagnosis often leads patients and families to seek deeper meaning in their lives. Some find that the disease brings them closer to their faith or spiritual beliefs, while others struggle to understand why cancer has affected them. Palliative care specialists can help individuals explore their beliefs and values to find peace or reach a sense of acceptance suitable for their situation.

Caregiver Needs: Family members are an essential part of cancer care and have their own needs. It's common for family members to feel overwhelmed by the additional responsibilities. Many struggle to care for a sick relative while managing work, household duties, and other family obligations. Concerns about how to assist their loved one with medical issues, lack of social support, and feelings of worry and panic can also contribute to caregiver stress.

Practical Needs: Palliative care experts can assist with financial and legal issues, insurance concerns, and employment matters. Addressing the goals of care is also a crucial part of palliative care, including creating advance directives and facilitating communication among family members, caregivers, and the oncology care team.

These challenges can impact caregivers' health. Palliative care professionals help families and friends cope, providing them with the support they need.

Expectations and understanding of illness

Palliative care in oncology not only helps relieve symptoms but also supports patients in understanding their disease and treatment goals. Chemotherapy is often used in metastatic settings to improve symptoms and stabilize the disease. However, a lack of understanding about the goals of therapy for incurable metastatic disease can hinder patients' ability to make informed decisions and delay end-of-life care preparation. Studies show that patients' treatment decisions are influenced by their understanding of treatment outcomes and burdens. Data from the Cancer Care Outcomes Research and Surveillance (CanCORS) study revealed that a significant percentage of patients with stage IV lung and colorectal cancers had unrealistic expectations about chemotherapy's curative potential. Despite this, patients with advanced cancers who did not expect a cure still received treatment at similar rates but were more likely to enroll in hospice services before death. This underscores the need for clear communication and realistic goal-setting in palliative care to help patients make informed decisions about their treatment and end-of-life care.

Evolution of cancer therapeutics

Over the past few years, the ongoing evolution of cancer therapeutics has significantly altered the landscape of oncology. The introduction of immunotherapy, which prevents inhibitory interactions between cancer cells and host immunity, along with the growth of precision oncology targeting individual driver mutations, suggests new treatment options that can extend overall and disease-free survival. However, as investigational therapeutics increase and clinical trial participation rises, oncologists and their patients must contend with the uncertainty of predictive knowledge. This creates a unique challenge for patients to engage in informed conversations with their oncology and palliative care teams, particularly regarding future planning and end-of-life care choices. Oncologists and palliative care specialists must address these uncertainties in each clinical meeting to manage expectations and support patients as they navigate their disease trajectories.

Interventional radiology (IR) and palliative care

Minimally invasive palliative methods conducted by interventional radiology (IR) uniquely enhance the quality of life and reduce suffering for cancer patients. Techniques such as percutaneous ablative and nerve-block procedures for pain control, vertebroplasty for fractures caused by skeletal lesions, and image-guided interventions to decompress malignant obstructions and drain persistent effusions or ascites, demonstrate the significant impact of IR on managing cancer-related symptoms. Integrating IR into a multidisciplinary approach is crucial to optimize supportive care for cancer patients. Effective decision-making for timely palliative interventions requires open communication among all members of the patient's healthcare team. Additionally, using validated disease-specific quality-of-life assessments in the periprocedural setting helps determine the appropriateness of interventions. These tools enable professionals to evaluate the efficacy of IR procedures in improving patient-reported outcomes and symptom management.

Conclusion

Palliative care is essential for the physical, mental, and psychosocial well-being of patients with advanced cancer. Its synergistic impact on overall survival, while enhancing patient comfort and quality of life, underscores the need for its integration with standard oncologic care. Ongoing dedicated research is necessary to evaluate the integration and expansion of high-quality palliative care services to meet the demands of a growing cancer population. Medical oncology and other specialties, including interventional radiology, must incorporate primary palliative care skills into their practice. They should collaborate with specialist palliative care physicians to help patients better understand and manage their illnesses, especially when the diseases are terminal.