Palliative Care/Hospice

Listen to the Cancer.net Podcast: Explaining Palliative Care, adapted from this content.

Today, doctors are able to cure many people diagnosed with cancer. Others are treated for several years with successive therapies, although they are not cured. Some experience unwanted side effects from treatment or discomfort due to either the cancer or the treatment. Helping people with cancer live well at every stage of their illness is the overall goal of palliative care. In fact, it is one of the most important goals of cancer treatment throughout the course of the disease (called the disease trajectory).

Defining palliative care

Palliative care includes treating the physical, spiritual, psychological, and social needs of a person with cancer. It starts at the beginning of the cancer process and may change over time to reflect each person's priorities and needs. Palliative care is not giving up on treatment. In fact, people with cancer may receive anticancer (curative) therapy and palliative care at the same time. In some settings, people switch and experience a transition from cure-oriented care to palliative, or symptom-oriented, care. In others, both forms of treatment are delivered simultaneously (at the same time), although the emphasis may shift toward comfort measures as the disease progresses.

Palliative care and hospice care

Although the terms palliative care and hospice care are sometimes used interchangeably, they have slightly different meanings. Palliative care applies to every step of the cancer process, whereas hospice care in the United States is used when the life expectancy is six months or less. Please read the article on hospice care for more information.

Purpose of palliative care

Five goals of palliative care include:

• To treat pain and all other physical symptoms caused by cancer or its treatment
  
• To address a person's spiritual needs or concerns
  
• To address a person's social needs, including financial concerns (see Financial Support Resources), and practical needs, such as transportation
  
• To treat a person's psychosocial needs, such as mood changes and depression
  
• To provide support for the patient's family, friends, and caregivers, which continues beyond the patient's death

Children can also receive palliative care. The World Health Organization (WHO) defines palliative care for children as the "total care of the child's mind, body, and spirit." Parents usually work with the health-care team to help their children feel as comfortable as possible. Care is also provided to other children in the family and counseling remains available for the entire family for many months afterwards.

The palliative care team

A variety of health professionals may participate as part of a team to give palliative care.

Doctor: Usually acts as the care team leader; makes treatment plans and decides on medication and dosing; may consult with other doctors such as pain specialists or radiation oncologists. The doctor may be available to make home visits or may supervise the care plan without actually seeing the patient.

Nurse: Gives direct care to the patient; can also assist with managing pain and other side effects of cancer or its treatment; may act as a liaison with the rest of the team. When people are enrolled in home hospice programs, nurses visit them at home several times a week and sometimes more than once a day.

Social worker: Helps with financial issues; arranges family meetings; assists with the discharge from the hospital to home or hospice care

Hospital chaplain or other spiritual advisor: Counsels the patient and family members on religious and spiritual matters

Dietitian: Helps with nutritional concerns

Physical therapist: Helps maintain movement and assists when mobility is impaired or there are concerns regarding safety in the home

Grief and bereavement coordinator: Helps with planning memorial services and counseling for the patient as well as family members

The PLWC Feature: The Oncology Team offers more information about these health-care professionals.

The role of communication

Communication is a central element of palliative care as it helps to clarify needs and expectations. The following are some practical tips to help promote good communication with the health-care team:

• Find doctors who are willing to answer questions and listen to your symptoms and your concerns.
  
• Ask questions about the diagnosis and treatment. Listen to the answers and ask the doctor to explain things that are not clear.
  
• Tell the doctor and nurse about pain, discomfort, or other side effects, such as mouth sores, nausea, vomiting, and constipation.

It is important for patients and caregivers to understand the diagnosis and prognosis (chance of recovery) and to participate in the medical decision-making process.

End-of-life considerations

Often, people with cancer or their families find it too painful to think about the possibility that the treatment won't cure the person's cancer. Sometimes, though, curative treatment will no longer slow or halt the growth of cancer or may be too toxic. The doctor and his or her patient may then decide to focus only on treatment aimed at maximizing comfort.

Talking about how to comfort a dying person is not easy for most people, and sometimes friends and relatives are afraid that if they mention death, they are giving up. In fact, most people, especially those with an incurable illness, have probably already thought about death. Discussing advance directives (instructions for medical care in the event that the person cannot communicate his or her wishes), hospice care, or memorial services can give the dying person some control over the situation and may help the grieving process for friends and family. It may also afford the family the opportunity to reaffirm love and promote a special closeness, which may help to ease the pain of separation. A social worker or chaplain may be able to help facilitate discussion of these issues. In addition, some palliative care services offer bereavement counseling to help friends and family members cope with loss.

Additional resources

LIVESTRONG: Quality of Live and Palliative Care

World Health Organization Definition of Palliative Care

Beth Israel Medical Center's Department of Pain Medicine and Palliative Care

Organizations

Hospice Education Institute provides referrals to hospice and palliative care organizations.

National Hospice and Palliative Care Organization (NHPCO), an organization committed to improving end-of-life care and expanding access to hospice care. NHPCA encourages all Americans to talk with their families about the kind of end-of-life care they would desire.

Center to Advance Palliative Care (CAPC)

More Information

End-of-Life Care

 

Reprinted with permission from American Society of Clinical Oncology®.
© American Society of Clinical Oncology, 2008. All rights reserved.