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When to incorporate palliative care into cancer treatment
In 2016, ASCO published a provisional clinical opinion addressing the integration of palliative care in oncologic clinical practice. The statement indicates that palliative care may begin at the time of diagnosis of metastatic or advanced disease.
ASCO statement, NCI recommendations
The investigators said palliative care is often mistakenly viewed as equivalent to end-of-life care, but it should be used to relieve suffering throughout the course of disease. The ASCO statement came in the wake of seven published randomized clinical trials demonstrating the relevance of palliative care as a method of improving quality of life, costs associated with cancer treatment and, possibly, survival in individuals with metastatic disease.
One specific study investigated concurrent palliative care and standard oncologic care from the point of diagnosis in a cohort of patients with non–small cell lung cancer. Results indicated no survival benefit, but early initiation of palliative care yielded improved symptoms, quality of life and satisfaction for patients, along with reduced burden on the attending caregivers. Hospice and intensive care were used more effectively and efficiently with the early introduction of palliative care, resulting in a cost benefit.
The investigators said the optimal method of delivering palliative care remains the subject of research. However, they still recommended early introduction for patients with metastatic disease or high symptom burden, according to the statement.
A fact sheet from the NCI provided a similar recommendation as the one from the ASCO panel. The NCI suggests that palliative care can begin at diagnosis and continue through the end of life, with palliative assistance given during treatment and at follow-up.
Components of palliative care
Palliative care may be administered by any health care professional who addresses symptoms, adverse events and emotional issues associated with malignancy. A palliative care team may consist of a doctor, nurse, dietitian, pharmacist, social worker, psychologist and/or a hospital chaplain, according to the NCI.
Patients may receive palliative care in the hospital or at home. Family members or close associates of patients also may receive palliative care.
Palliative care may deal with physical issues such as pain management, sexual functioning or fatigue; emotional issues such as depression, anxiety and fear; practical issues, including financial and legal concerns, employment-related questions and insurance coverage; and spiritual issues regarding why the disease happened and how the diagnosis may affect the faith of the patient or the patient’s loved ones.
Hospice vs. palliative care
While hospice and palliative care both provide the patient with comfort, palliative care can be initiated at diagnosis and during treatment, whereas hospice care begins once treatment has stopped. Hospice care is administered when it is known that the patient is not expected to live longer than 6 months.
Palliative care nurse
The role of the palliative care nurse is to improve the quality of life for patients with a life threatening illness, as well as their family members. A palliative care nurse may have many different job responsibilities and may work in a variety of settings. These work settings include hospitals, hospices, nursing homes and patients’ homes.
Additional information can be found by searching the following websites:
www.cancer.gov/cancertopics/factsheet/Support/palliative-care
www.cancer.net/all-about-cancer/treating-cancer/caring-symptoms-cancer-and-its-treatment
www.medlineplus.gov/ency/patientinstructions/000536.htm
www.pcna.org.au/what-we-do/palliative-care-nursing