Palliative care is a fundamental part of patient-focused, integrated healthcare services. Nothing is more patient-focused than suffering relief, regardless whether it’s physical, psychological, social or spiritual.
Therefore, regardless where suffering originates from – be it cancer, organ failure, severe burns, chronic terminal illness, prematurity or age-induced frailty – palliative care or support care, as it might also be designated, might be necessary and must be integrated into therapy.
This approach improves not only a patient’s quality of life, but also that of their loved ones, who face illness-related issues alongside them; it avoids and relieves suffering through early recognition, correct evaluation and treatment for pain and other issues.
All necessary investigations for understanding and choosing protocols to care for complications and stressing symptoms related to illness treatment and evolution must be part of palliative care.
A piece of trivia: the word “palliative” comes from latin “pallium”, meaning “protective cloak”, and “palliare” means “to protect, to accept, to shelter”. Protecting someone is a form of care. In advanced cancer patients, in which some treatments are fundamental for symptom control, palliative care is extremely important.
Principles of palliative care
We need to demystify the idea that palliative care is only adopted for terminal patients, when there’s no more possibility for treatment. Its main goal is, actually, promoting quality of life for patients and other people in their lives through prevention and suffering relief in any stage of illness.
Its principles are:
- Promoting relief for pain and other distressing symptoms, such as asthenia, anorexia, dyspnea and other oncological emergencies;
- Affirming life and recognizing death as natural processes;
- Not hastening nor delaying death;
- Integrating psychological and spiritual aspects as part of patient care;
- Offering a support net for patients to live as actively as possible until their death;
- Offering a support net for family and friends to deal with the illness in their own environment; and
- Using a multidisciplinary approach to access both patients’ and their support nets’ clinical and psychosocial necessities, including grief counseling and support.
When should palliative care start with a cancer patient
A cancer patient’s palliative care should start as early on as possible. They might be working in tandem with therapy aiming for the cure, taking on an important role in handling difficult symptoms and improving patient’s clinical conditions.
Understanding that a patient with an illness such as cancer doesn’t have to choose between a medical team aiming for the cure (oncologists and hematologists, as an example) and a palliative care team is fundamental. Advanced oncological illnesses or people undergoing cancer treatment with difficult symptoms have benefits in receiving concomitant care.
Palliative care is integrated, with the entire medical and multiprofessional team performing extremely important functions. Palliative care doctors, nurses, social workers, pharmacists, physiotherapists, occupational therapists, psychologists, nutritionists, speech therapists and spiritual assistants work together aiming the best conditions for their patient and support net.
As the illness advances, even as cure-focused treatment is underway, palliative approach must broaden towards psychological, social and spiritual aspects. On terminal stages, when the patient doesn’t have a lot of time left, palliative care persists and is done in such a way to ensure quality of life, comfort and dignity.
Which oncology patients must be referred to palliative care
In oncology, ASCO (American Society of Clinical Oncology) established in 2017 which patients should have palliative care monitoring. Those are:
- Oncology patients in advanced (metastasis) stage; and
- Cancer treatment patients with difficult symptoms at any illness stage.
Patients with advanced or refractory haematologic neoplasia and those with high symptom load and/or biopsychosocial needs also benefit from this approach.
What benefits does palliative care have in oncology
Palliative care monitoring brings several benefits, such as:
- Improving symptom management;
- Having a comprehensive vision of patients and their families;
- Valuing patients’ autonomy, always respecting their values and priorities;
- Planning individualized care, according to each patient’s needs and physical, social, family, emotional and spiritual context;
- Having a humanized vision of those involved in patient care, while also preventing their stress; and
- Having a transdisciplinary team’s support while confronting illness and treatment.
At Oncoclinicas Group the Palliative Care program is the Continued Care team, look up whether this service is offered at your unit.
Dr. Sarah Ananda Gomes