Palliative Care and Cancer

Let’s start with a very important distinction: palliative care is not the same as hospice care. There continues to be some confusion about this as the two historically were one and the same. As you likely know, hospice care is intended for people with an anticipated life expectancy of six months or less. Palliative care is directed at people who are living with a serious illness. The focus is on relieving physical symptoms, minimizing stress, and generally improving physical and emotional quality of life for both the patient and the family.

A consultation with the palliative care team can bring comfort and value to your life if you are contending with symptoms from a serious illness.

Palliative care is now a medical specialty, and there are physicians and nurses who are trained and identified as experts in the field. Palliative care providers work closely with the patient’s other doctors, but do not replace them. It can be appropriate and helpful at any stage in a serious illness and can be provided alongside of curative treatment. People with cancer, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), kidney disease, Alzheimer’s Disease, Parkinson’s Disease, and many other illnesses may be referred to palliative care with the goal of improving their lives.

Palliative care is usually provided by a team of clinicians who work together to address the patient’s particular needs. BIDMC's Palliative Care service works both with people who are hospitalized and people who are receiving out-patient or ambulatory care. The team at BIDMC includes physicians, nurse practitioners, chaplains, and social workers. They are able to reach out to other specialists within the medical center whose expertise may bring more value to an individual’s care.

What kinds of symptoms do palliative care providers address? Commonly, they work to improve pain control, depression, breathing difficulties, fatigue, GI issues like constipation or diarrhea, nausea, loss of appetite, sleep difficulties, and anxiety. Anything that is interfering with a patient’s enjoyment of life can be addressed. This is one area of medicine where very close attention is paid to the patient’s values and goals. The palliative care team can help with difficult medical decisions, sorting through treatment options, and being certain that the choices that best align with your goals are made. Often, they consult with your medical oncologist or other doctors to confirm that everyone is thinking about the patient’s overall quality of life and to share information that may improve respectful and individualized care.

When speaking with someone who is struggling through cancer, I sometimes ask about palliative care. The immediate reaction is almost always negative. Most people still believe that palliative care is only for those who are nearing the end of life, and a little education is needed. When I have been able to describe the support that the palliative care team can bring, almost everyone is eager to schedule a consultation.

Let me give you a couple of examples. One example is a 50-year-old single woman living with Stage IV breast cancer. Although her cancer was quite well controlled, and her oncologist was reassuring that she had a great deal of time ahead, she was experiencing chronic GI issues that too often made her miserable. Somedays she was afraid to venture out and be distant from her bathroom, while other days she was uncomfortably constipated. She had talked with her oncologist about these problems, but there were always so many other cancer issues to be discussed that the focus had been elsewhere. When she met with the palliative care team, they talked with her about the restrictions these problems were putting on her life and then concentrated on how to make things better. With some changes in her diet and medications, she felt much improved, and these issues mostly disappeared.

Another example is a 70-year-old woman with recurrent ovarian cancer. She, too, was doing quite well with her cancer treatment, but was very frightened about death. Sometimes her anxiety made it impossible to sleep and dominated her thoughts during the day. She did not have a connection with a clergy person and was reluctant to reach out to someone in her community. When we talked about the central role of interfaith chaplains in the palliative care group, she was immediately interested in speaking with them. Not having to identify with a particular faith was easier, and she liked the idea that speaking with someone about faith, belief, and death could be part of a larger evaluation of how to live her best possible life.

In summary, a consultation with the palliative care team can bring comfort and value to your life if you are contending with symptoms from a serious illness. Do not be hesitant to consider their services.