Palliative care can be a difficult subject for health care professionals to discuss with their patients. This difficulty may stem from the fact that some physicians focus on treatments aimed at increasing survival time for their patient rather than comfort measures that may improve patient and family satisfaction. While palliative care is not a new topic in health care, its true value may not have been fully realized until recently.1,2

Palliative care is an interdisciplinary approach, but it should be initiated by the primary oncology team and then transitioned to a team of palliative care experts including nurses, chaplains, social workers, rehabilitation experts, and members of several medical specialties.3,4 

Palliative care, at its core, refers to taking care of patients, and it should not be the last option in a patient’s treatment plan.2 While hospice is typically associated with end-of-life care, palliative care can be offered throughout the patient’s course of therapy, and, according to an original article by Hennessy and colleagues in the Journal of Oncology Practice, should be integrated throughout cancer treatment as the standard of care. Early integration will allow the physician to discuss palliative care options with their patient in a controlled setting, and will subsequently allow patients to make informed decisions about their own care. This will lead to smoother transitions into end-of-life care conversations, if needed.2

There are many benefits to integrating palliative treatments into cancer care, perhaps the most significant being improved patient outcomes. A 2007 study looked at the survival rates of patients with less than 3 years of life expectancy who were enrolled in hospice versus those not enrolled in hospice care. The study found that the mean survival for patients in hospice was 29 days longer than for non-hospice patients.5  


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Providing adequate pain management is an important component of palliative care. Originally, pain management was thought to decrease overall patient survival and only included options such as oral opioids.6 However, an article by Chang and colleagues discusses other pain management options that can be used in conjunction with analgesic medications, specifically psychological interventions and physical rehabilitation. Physical rehabilitation improved mobility scores by 27%and resulted in 78% patient satisfaction as a result of the increased mobility.7

Psychologic interventions, such as chronic behavioral therapy (CBT) or hypnosis, have been studied in advanced cancer patients as a method for pain management; however, further research needs to be done to determine the full benefits of CBT in this specific patient population.7 Other studies examined by Chang et al resulted in similar patient satisfaction and functional status scores among patients with advanced cancer who received these palliative treatments.7   

There are various approaches that exist to manage a patient’s level of pain; however, there is no standard formula, so it is important for health care professionals to realize that each patient will have different needs and goals, and so their pain should be managed accordingly.

Overall, palliative care given in conjunction with standard oncology treatments should become part of the norm, as the optimization of symptom management and an improved quality of life can ultimately mean better outcomes for the patient, whether or not their cancer is terminal.


References

1. Cheng MJ, King LM, Alesi ER, et. al.  Doing Palliative Care in the Oncology Office.  Journal of Oncology Practice 2012; 9(2):84-88.
2. Hennessy JE, Lown BA, Landzaat L, et al.  Practical Issues in Palliative and Quality-of-Life Care.  Journal of Oncology Practice 2013; 9(2):78-80.

3. Gavrin JR, McMenamin EM.  Pain Management in Palliative Care Oncology Patients.  Current Pain and Headache Reports 2008; 12:257-261.

4. NCCN Clinical Practice Guidelines in OncologyTM.  Palliative Care. v 2.2012.  Available at:  http://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf.  Accessed April 1, 2013.

5. Connor SR, Pyenson B, Fitch K, et. al.  Comparing Hospice and Nonhospice Patient Survival among Patients Who Die Within a Three-Year Window.  Journal of Pain and Symptom Management 2007; 33(3): 238-246.

6. Giordano J, Gomez CF, Harrison C.  On the Potential Role for Interventional Pain Management in Palliative Care.  Pain Physician Journal 2007; 10:395-398.

7. Chang VT, Sorger B, Rosenfeld KE, et. al.  Pain and Palliative Medicine.  Journal of Rehabilitation Research and Development 2007; 44(2):279-294.