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What Does Palliative Care Mean For Cancer Patients

Palliative Care For Cancer Patients: How Does It Help

What is Palliative Care An Introduction for Patients and their Families

New Brunswick, N.J., August 12, 2021 There are many misconceptions about the purpose of palliative care and what it involves. Many people think that it is simply end-of-life care, or that it means stopping cancer treatment. For cancer patients undergoing treatments, palliative care can provide excellent pain and symptom management that can help them feel better. It can also address the challenges that could keep patients from receiving further cancer treatments due to uncontrolled symptoms. In certain cases, an approach of combined palliative care along with cancer treatments can help increase both quality of life and improve overall survival.

Samantha Nagengast, MD, is the director of the Palliative Medicine and Supportive Care Program at Rutgers Cancer Institute of New Jersey and Robert Wood Johnson University Hospital, an RWJBarnabas Health facility. She along with M. Hamza Habib MD, FACP, FAAHPM, MRCP, director of Outpatient Palliative Medicine and Cancer Pain Service at Rutgers Cancer Institute, and oncologist and palliative medicine physician Elizabeth Poplin MD, collaborate on the management of palliative care for patients with cancer. They answer common questions about how palliative care can enhance quality of life and survival rates for this population.

What is palliative care?

What is the difference between palliative care and hospice care?

What are some issues patients might experience that palliative care helps to address?

Can I Still Have Cancer Treatment

You can still have active treatment to shrink the cancer or stop it growing. The palliative care team will work with your cancer specialists to manage any side effects from treatment and maintain your quality of life.

Cancer treatment such as radiation therapy, drug therapies and surgery may also be used as part of palliative care. In this case, the aim is not to cure the cancer but to control it or relieve symptoms.

Expert Review And References

  • Esper P. Principles and issues in palliative care. Yarbro, CH, Wujcki D, & Holmes Gobel B. . Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett 2011: 74: pp. 1815-1828.
  • Paice JA. Care during the final days of life. Yarbro, CH, Wujcki D, & Holmes Gobel B. . Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett 2011: 75: pp. 1829-1842.

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Who Can Benefit From Palliative Care

Palliative care is available to all patients with serious illness regardless of age, prognosis, disease stage, or treatment choice. It is ideally provided early and throughout the illness, together with life-prolonging or curative treatments. In other words, patients dont have to choose between treatment for their illness and palliative care they can have both.

Palliative care not only improves the quality of life of patients and their families, reducing mental and physical distress and discomfort, but also can help patients live longer. The prolonged survival is thought to be due to improved quality of life, appropriate administration of disease-directed treatments, and early referral to hospice for intensive symptom management and stabilization.

The Science Behind Palliative Care

The Truth About Palliative Care: The What, Who, How, &  Why

A 2012 study demonstrated that cancer survivors’ health-related quality of life is influenced by both physical issues and emotional problems. Approximately 1 in 4 cancer survivors reported poor physical health and 1 in 10 reported poor mental health.

A 2010 study published in the New England Journal of Medicine concluded that some lung cancer patients receiving early palliative care had a prolonged survival of approximately two months and clinically meaningful improvements in quality of life and mood. Additionally, a 2016 analysis of more than 40 studies concluded that palliative care improved patients’ quality of life and relieved many symptoms.

In updating its guidelines and recommendations for palliative care services in 2016, the American Society of Clinical Oncology noted, “Inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment.”

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Who Can Have Palliative Care

After you get a terminal diagnosis, you can have palliative care at any stage in your illness. You can also have palliative care alongside treatments, therapies and medicines aimed at controlling your illness, such as chemotherapy or radiotherapy.

However, palliative care does include caring for people who are nearing the end of life this is sometimes called end of life care.

Palliative care may also be able to support the people close to you, including friends, family and carers. They may be able to speak with professionals who can offer practical and emotional support.

Allied Health Care And Referral To The Local Hospice Palliative Care Program

  • High quality palliative care is generally provided via a team approach and GPs are important team members as they often have good relationships with patients and families and the knowledge and expertise to coordinate and provide care for the whole patient. Team members may include medical specialists, advanced practice nurses, home care nurses, social workers, case managers, pharmacists, occupational therapists, physiotherapists, dietitians, spiritual care workers, hospice volunteers, and home support workers.
  • Patients are often best educated by allied health providers when it comes to topics such as myths about opioids, proper use of breakthrough medications, managing side effects, accessing help after hours, how to plan a home death, etc.
  • Refer to the local hospice palliative care program early in the illness trajectory so patients and their families can learn what supports are available before they are required.

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Making The Most Of Palliative Care Services

If you or a loved one is living with serious illness, ask your primary or specialty care doctor for a palliative care referral. If palliative services are not available locally, your doctor may explore your palliative or hospice needs with you directly.

Use this discussion and the resulting services as an opportunity to:

  • Assess and manage poorly controlled physical, psychological, social, and spiritual stressors.
  • Understand your illness, its expected trajectory, and treatment options.
  • Explore your hopes, worries, goals, and values cultural or religious beliefs that impact your care or treatment decisions treatments you may or may not want what quality of life means to you.
  • Discuss and document your health care proxy and end of life preferences, including medical interventions you do or do not want.

It is never too early to ask how palliative services can help you or your loved one live well. Learn more from the Center to Advance Palliative Care.

About the Author

Ashwini Bapat, MD, Contributor

How Do You Know When Death Is Hours Away

Understanding Palliative Care and Hospice for Cancer Patients

When a person is just hours from death, you will notice changes in their breathing:

  • The rate changes from a normal rate and rhythm to a new pattern of several rapid breaths followed by a period of no breathing . …
  • Coughing and noisy breathing are common as the body’s fluids accumulate in the throat.
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    Emotional And Spiritual Benefits

    Palliative care means different things to different people. For some, it may not only address physical symptoms and side effects of cancer, but also emotional and spiritual needs.

    Many people who are diagnosed with cancer or who are dealing with cancer treatment develop emotional distress in the form of conditions like anxiety or depression. Treating a patient’s emotional needs may require medications as well as one-on-one therapy with a licensed professional counselor .

    Counseling and therapy should be an interactive process where patients take the lead, says Diane Schaab, MS, LPC, Behavioral Health Therapist at CTCA® Atlanta. This empowers you to take control of your mental health, she says, adding that because theres a wide variety of mental health strategies, each should be individualized to the patients needs.

    Spiritual counseling with a chaplain or spiritual care advisor may also help relieve stress for cancer patients. Its important to know that you dont have to be religious to receive this type of palliative care. Chaplains are trained to work with people from every faith and background, including people with no religious beliefs.

    When Can Palliative Care Help

    Palliative care can help anyone with cancer who is experiencing physical or emotional discomfort.

    Palliative care can help reduce cancer symptoms, which may include pain, fatigue, nausea and constipation, and can reduce side effects from cancer treatments.

    Some people receive palliative care for several years as improved cancer treatments may be able to slow or stop the spread of advanced disease and relieve symptoms even if it cant be cured.

    Palliative care can also help if you are experiencing depression or anxiety due to your cancer diagnosis. Counselling and support services can help address many fears, worries or conflicting emotions.

    If you have advanced cancer, a social worker or counsellor can help you work out your goals and how best to achieve them. These goals may be specific end-of-life wishes, but can also simply involve making the most out of each day.

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    European Society For Medical Oncology Guidelines

    The ESMO guidelines propose combining nutritional support with exercise training and psychological support in patients with cachexia, and recommend considering anti-inflammatory interventions.18 Like the NCCN, ESMO takes life expectancy into consideration, with recommended approaches as follows:

    • In all patients undergoing anticancer treatment and those with a life expectancy of at least 3-6 months, standardized screening for nutritional risk at regular intervals, using a validated screening tool, along with interventions to counteract deterioration of body resources and metabolism, and to alleviate debilitating symptoms
    • In patients with an expected survival of less than a few months, a decrease in the invasiveness of nutritional interventions, with dietary counseling and oral supplements preferred if possible.
    • In patients with an expected survival of less than a few weeks, comfort-directed care, including alleviating thirst, nausea, vomiting, and dysphagia, and psychological and existential distress, as well as distress to family members

    ESMO recommendations on nutritional interventions are as follows:

    ESMO recommendations regarding pharmacologic therapy for cancer cachexia include the following:

    How Does A Cancer Patient Benefit From Palliative Care

    What is Palliative Care? â Bangladesh Palliative &  Supportive Care ...

    Doctors tailor treatment and care plans based on the type of cancer and the individual. A palliative care plan is no different, the individual will always receive a personalised care plan. Some cancers are more aggressive or widespread, so may need more extensive palliative care than others. However, palliative care is available for any and all types of cancer.

    The many benefits of palliative care for cancer treatment include:

    • Managing wounds or stomas
    • Additional medications for side-affects

    You can speak to your doctor or healthcare provider as soon as the diagnosis is given. You do not have to wait for a certain point of cancer treatment. It is also available post-op if that is part of your cancer treatment.

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    Can You Receive Palliative Care At Home

    You can receive palliative care at home as well as in the hospital. Many people with cancer prefer to have treatments at home as it is a place they feel most comfortable. For a man, being able to have palliative care at home can provide a resemblance of normality. Family and friends can continue to visit and be part of the support network for the individual. If you do require palliative home care there are options available. We at Cavendish Homecare do not underestimate the value and importance of providing palliative care in the home. We have extensive experience of palliative care for cancer patients. One of our cancer care case studies will help you to learn more about the specific help we provide.

    We are one of the leading providers of bespoke Cancer Care in the UK, offering superior and flexible support. Everything from day-to-day care to highly specialised clinical expertise is available to our clients.

    The experience our team has within the NHS and private healthcare sector means we can work closely with multidisciplinary teams to maintain the best support based on individual needs, never a one size fits all care plan.

    Cavendish Homecare can provide a whole host of palliative care options including:

    • A Registered Nurse or Carer to accompany you to and/or from appointments
    • Someone to be on-hand during your treatment
    • Support coping with the side-effects of chemotherapy or radiotherapy
    • Assistance with rehabilitation following surgery for cancer

    Do I Have To Pay For Palliative Care

    The federal, state and territory governments fund a range of palliative care services that are free in the public health system whether you receive care in a hospital, residential aged care facility or at home.

    You may need to pay part of the costs of care. This might include:

    • paying for medicines
    • hiring specialist equipment for the home
    • paying for nursing staff if you choose to stay at home and need 24-hour assistance
    • using short-term care that charge a fee
    • paying the fee for a private allied health professional such as a physiotherapist or psychologist
    • paying for complementary therapies.

    You can get more information by contacting your state or territory palliative care organisation.

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    Palliative Care Provides Spiritual And Emotional Support

    When curative treatment is no longer an option, the significance is placed on how to measure comfort and emotional well-being. The purpose of Palliative Care is to provide those with life-threatening illness an opportunity to live life as fully as possible, and to show them that they are supported and loved.

    Integracare makes a promise to provide compassionate, knowledgeable assistance and support to our Clients and their families.

    In-home care for Clients with cancer allows them to be close to family and loved ones, and they can enjoy the familiarity of their own home during a strenuous time, and feel confident and relaxed.

    What Are The Generally Beneficial Consequences Of Hospice Care

    Supportive Oncology – The Role of Palliative Care for Patients with Cancer

    Whether you are already familiar with hospice or are seeking information, you may be unaware of the many benefits hospice care provides for cancer patients and their families. If you or a loved one is battling advanced cancer, hospice can offer the following:

    • Hospice provides individualized care and support to patients and families during this challenging time in their lives. We are receptive. We are advocates. We strive to improve peoples quality of life.
    • Reduced readmissions. As the condition progresses, symptoms may worsen, and many patients are forced to make frequent emergency room visits or endure repeated hospitalizations.
    • Hospice decreases readmissions by addressing pain and signs in the patients home.

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    Cannabis Oil Does Not Relieve Distress In Cancer Patients: Study

    The CBD or cannabidiol oil does not improve the pain, depression, anxiety or quality of life among the palliative care patients with advanced cancer, found a study by Brisbane-based Mater hospital and the University of Queensland.

    The trial studied the effects of cannabidiol oil on the relief of pain, depression, anxiety and quality of life on 144 patients receiving palliative care for cancer. This was a double-blinded trial, which meant that neither the researchers nor the participants of the study knew whether they were getting medicinal cannabis or a placebo.

    The findings have been published in the Journal of Clinical Oncology.

    The trial found there was no detectable effect of CBD on change in physical or emotional functioning, overall quality of life, fatigue, nausea and vomiting, pain, dyspnoea or appetite loss, lead author of the study and the director of palliative and supportive care at Mater, Prof Janet Hardy, said.

    But she added that the study only examined the effect of CBD.

    The cannabis plant is very complex and contains a large number of cannabinoids and other compounds, she said. The two most prominent cannabinoids are CBD, which is cannabidiol, and THC, which is the one that makes you high when you smoke a joint.”

    Hardy said it may be that CBD contributes to a greater feeling of general wellbeing, even if it did not improve specific symptoms.

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    Actively Dying: The End

    There are several points to consider when patients enter the dying phase:

    • Review a patients goals of care, preferred place of care, and what to do in an emergency.
    • Refer the patient to home nursing if not already arranged.
    • Consider hospice palliative care referrals.
    • Ensure that the required forms are completed .
    • Discontinue non-essential medications.
    • Arrange for subcutaneous /transdermal medication administration or a drug kit to be placed in the home when a patient is no longer able to take medications by mouth .
    • Arrange for a hospital bed +/- pressure relief mattress.
    • Arrange for a Foley catheter, as needed.
    • Leave an order for a SC anti-secretion medication .

    Recognition of and preparation for complex grieving optimally takes place before death occurs in BCGuidelines.caPalliative Care Part 3: Grief and Bereavement).

    At time of death:

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    What Are The Signs That The Person Has Died

    • The person is no longer breathing and doesnt have a pulse.
    • Their eyes dont move or blink, and the pupils are dilated . The eyelids may be slightly open.
    • The jaw is relaxed and the mouth is slightly open.
    • The body releases the bowel and bladder contents.
    • The person doesnt respond to being touched or spoken to.
    • The persons skin is very pale and cool to the touch.

    Establish Goals Of Care With Patients And Families

    ABC of palliative care: Care in the community

    As the underlying condition progresses, a patients goals of care often become less disease-specific and more palliative.

    Discuss a patients wishes before clinical deterioration, possibly over several visits. Start by determining how much the patient desires to know about their disease and how much they desire to participate in decision making. When translation is required, a professional interpreter is advisable.

    • Enquire regarding cultural and individual preferences. Factors such as age, gender, religion, and culture can affect patient and caregiver approach to palliative care and conversations about end of life. The Canadian Virtual Hospice has resources supporting culturally-sensitive palliative care including the online resource livingmyculture.ca.
    • Well-established communication strategies such as The Serious Illness Conversation Guide6 can be helpful for discussing goals of care. Refer to Associated Document: The Serious Illness Conversation Guide.
    • Determine the patients understanding of the disease and condition.
    • Discuss the anticipated course of the illness, treatment choices, and options in relation to a patients preferences, needs, and expectations.
    • Document advance care planning discussions and the existence of any Advance Directive/Representation Agreement.
    • In the absence of a representation agreement, identify a Temporary Substitute Decision Maker .
    • Notification of Expected Death in the Home , and
    • Medical Orders for Scope of Treatment .

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