Mention the term “palliative care,” and what comes to most people’s minds is hospice care provided at end of life. While these two concepts have much in common and share certain objectives, there is a significant distinction between the two that patients fighting a serious illness, such as cancer, need to understand.
According to Heidi Nichols, CNP, of The Toledo Clinic Cancer Centers, “Palliative care is not synonymous with hospice. Its focus is on symptom management and maximizing the patient’s quality of life, but initiating palliative care doesn’t necessarily mean you’re no longer trying to cure the disease. In fact, palliative care can be utilized while patients are still on active treatment to reduce their symptoms and help them get through it.”
Nichols further explains that hospice care is not indicated until treatment is no longer working (or is causing more harm than good), the disease is progressing despite the care team’s best efforts, and the patient’s life expectancy is six months or fewer. While palliative care is a vital aspect of hospice, not all patients receiving palliative care are candidates for hospice.
In treating cancer patients, palliative care involves much more than oncology. It’s a multidisciplinary team approach that addresses emotional, psychosocial, and spiritual issues along with physical symptoms. There are even palliative treatments that are intended to reduce symptoms rather than cure the cancer. For example, if reducing the size of a tumor will improve pain or other unpleasant symptoms, treatments such as radiation, chemotherapy, or hormone therapy can be utilized for that purpose. “However, when using these treatments with palliative rather than curative intent, we’re much less tolerant of side effects because the focus is on quality of life as well as extension of life,” says Nichols.
While palliative care won’t cure cancer, patients receiving it often have greater longevity in addition to improved symptoms. In some cases, this outcome can be attributed to reducing symptoms that are directly life-threatening, such as difficulty breathing, but in other instances, it has more to do with an increased will to live. As Nichols observes, living with the symptom of constant pain can be very fatiguing and demoralizing for patients. Relieving that pain can actually make patients feel good enough to want to live longer and fight their disease. And with all the pain medications and therapies available to oncology practitioners today, it’s rare that pain cannot be effectively managed with some method or combination of methods.
Family caregivers also tend to benefit when palliative care is provided. Of course, no one wants to see their loved one suffer, but there’s also a sort of “trickle-down effect” when the patient is suffering less. To illustrate this effect, Nichols uses the example of a female patient with lung cancer who was staying with her adult children and having difficulty breathing at night. She would have to wake up multiple times throughout the night to use her inhaler, so no one in the home was getting any rest. “We were able to intervene with some medications, diuretics, aerosols, and some adjustments to her oxygen that didn’t affect her cancer but greatly improved her breathing, so everyone started sleeping better,” she says.
Perhaps the biggest misconception patients have about palliative care is that it signals the end and that their caregivers are no longer working to cure them. “We try to reassure our patients that starting palliative care doesn’t mean we’re giving up on a cure. We’ll always be involved in their care, and they’ll always be our patient. Even if the focus does change from active treatment to supportive care, we’ll be no less involved in their care,” says Nichols. ❦