Palliative Care is Part of Good Cancer Care
Deborah, a 36-year-old mother of two young children, was diagnosed with breast cancer 2 years ago, and the disease has metastasized (spread) to her bones. The pain is severe, making it hard to care for her children or get to work.
Like any young mother, Deborah is determined to fight her cancer and be present for her son and daughter as they grow up. Deborah's oncologists, doctors at the top of their field, are intensely focused on controlling her cancer and identifying the chemotherapy plans that are most likely to work for her. But they have been unable to manage Deborah's pain. It had become so bad that she was unable to sleep or eat, spending much of the day curled on her side in bed. She missed a course of chemotherapy because of her pain, and she had to hire outside help to get her kids to and from school.
Deborah's long-time internist finally referred her to the palliative care team at her local hospital. They prescribed a low-dose opioid medicine and within 2 days, Deborah's pain was well controlled, she was up and around, sleeping and eating, and back to normal life with her family. She has been able to complete her latest course of chemotherapy and her oncologist feels her scans are showing a good response to the treatment.
Deborah's story is not unique. She is one of many thousands of people with cancer who have benefitted from palliative care, so that she can enjoy some normal day-to-day function and quality of life while she fights cancer.
Palliative care for any stage of disease
Palliative care, sometimes called "supportive care," is medical treatment for people with serious illness. It's most often begun by the cancer care team, and referrals to or visits with palliative care specialists may happen later. Teams of palliative care specialists typically include doctors, nurses, social workers, and other healthcare professionals who work together with the patient, their family, and their other doctors to provide an added layer of support. The team works with the patient to provide relief from the pain and other symptoms, as well as the distress of their illness, so that the patient can live as well as possible.
As in Deborah's case, palliative care can be provided at the same time as treatment to cure the disease. In fact, patients should have access to palliative care at any age and at any stage of a serious illness.
Deborah's goal was to continue to fight her cancer aggressively, but her palliative care needs - in her case, disabling pain - impacted her ability to get treatment and posed significant burdens on Deborah, her family, and her medical care team. Once Deborah's pain was addressed, she was much better able to continue her fight against the cancer.
Get palliative care sooner, rather than later
Modern medicine has great tools for treating cancer effectively. But radiation treatments and chemotherapy have side effects that can seriously diminish quality of life, making the added layer of support provided by palliative care even more important. Palliative care can help address distress of all types: pain, fatigue, nausea, lack of appetite, sleeplessness, constipation, anxiety, and worry. Managing symptoms can help patients better cope with medical treatments and carry on with daily life.
Think of it this way: oncologists treat the patient's cancer; palliative care teams treat the cancer patient.
Research has shown that palliative care improves symptom distress, quality of life, patient and family well-being, and in a number of recent studies, survival.
In fact, the sooner patients receive palliative care after diagnosis, the better. Waiting until symptoms become serious could actually be harmful. There's a growing body of evidence documenting the harmful effects of pain and symptom distress.
Pain can make it harder to stick with medical treatments, as in Deborah's case. Because of its effect on sleep, appetite, and mood, pain also slows recovery and often leads to depression. When cancer patients are depressed, science shows they die earlier. Depression is one of the common side effects of cancer that palliative care can help to address. This supports earlier and greater involvement of palliative care in the treatment of cancer.
Studies show longer life with palliative care
A groundbreaking study by Jennifer Temel, MD, published in the New England Journal of Medicine in 2010, describes the success of introducing routine palliative care evaluations and ongoing support for patients newly diagnosed with lung cancer. The results of the study were that patients felt better, were less depressed, were less likely to die in the hospital, and were less likely to be in the hospital in their last month of life.
Patients who got palliative care at the same time as their cancer treatment lived nearly 3 months longer than similar patients getting only best cancer care but not receiving palliative care.
Four studies have shown that when palliative care teams work together with oncologists, patients are able to remain at home - they don't end up in the ER and hospital with pain and symptom crises. As a result, they go through fewer unnecessary tests and procedures. It's no wonder that patients who get palliative care at the same time as their cancer treatment not only feel and do better, but also live longer.
Palliative care has become the fastest growing medical specialty in the United States. Almost 90% of large hospitals (300 beds or more) now have palliative care programs, and most cancer centers have added palliative care supportive services.
If you or a loved one has cancer, don't wait until symptoms become serious and you are unable to cope. Ask your doctor about palliative care and and get the help you need to be as comfortable as possible, with the highest quality of life, throughout and after cancer treatment. To learn about palliative care, whether it might be right for you, or to find a palliative care team in your community, you can also check out getpalliativecare.org.
Read more about palliative care.
Dr. Meier is the director of the Center to Advance Palliative Care at the Mount Sinai Medical Center in New York City.