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CURE COMMUNITY
Palliative care at diagnosis
BY LENA HUANG | AUGUST 20, 2010
Yesterday, The New England Journal of Medicine published a study endorsing early palliative care for patients with metastatic lung cancer. The study found that patients who were assigned palliative care at diagnosis had a better quality of life, had less depression, and lived longer (approximately two months) than patients assigned to standard care.
Palliative care focuses on creating the best quality of life for patients suffering from symptoms of a disease. This may be by alleviating treatment side effects, such as pain, with medication. It can also be through providing nutritional advice or even spiritual counseling. Palliative care is a holistic approach to caring for a patient's mind and body so that he or she will be in the best possible condition for treatment and to enjoy daily life.
So it seems obvious palliative care is available to everyone, right? Not so, says an accompanying editorial to the NEJM study. "Despite the increasing availability of palliative care services in U.S. hospitals and the body of evidence showing the great distress to patients caused by symptoms of illness, the burdens on family caregivers, and the overuse of costly, ineffective therapies during advanced chronic illness, the use of palliative care services by physicians for their patients remains low. Physicians tend to perceive palliative care as the alternative to life-prolonging or curative care--what we do when there is nothing more that we can do--rather than as a simultaneously delivered adjunct to disease-focused treatment," says Amy S. Kelley, MD, and Diane E. Meier, MD, from Mount Sinai School of Medicine.
In 2008, CURE featured an article on palliative care that brought to light the importance of this specialty, especially for cancer patients who suffer many side effects of treatment. More and more, we are seeing cancer patients living with metastatic or chronic disease, sometimes waiting for the next greatest therapy and sometimes keeping the cancer at bay with cyclical treatments. With palliative care to help ease their burdens, these patients can continue to enjoy daily life and hopefully be stronger physically and mentally to undergo treatment.
Perhaps this is best put by Patty Szostak, a cancer patient who received palliative care and who was interviewed for our story. "I do get scared. But I am able to feel joy. And I still have a mental image of myself at age 90 in my garden with the cats running around, and me pressing seeds into the ground. That's the picture I have. And I'm not giving up on it." That level of hope and joy should be available to all cancer patients.
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There is no benefit to push palliative care by pharmaceutical companies, therefore nothing to be gained by doctors either.
I, like Patty, prefer to think of the future I will be spending with my grandchildren in the garden and enjoying life. This along with a good diet is what keeps me strong and positive!!!
I do get scared, but have a great support group of family and friends to get me through it.
- Posted by Jane 8/28/10 8:39 AM
I think that a large factor in not providing palliative care with cancer therapy has to do with how the doctors themselves cope with the disease. Where I work their are several oncologists who keep pushing aggressive treatment until a patient is obviously dying and often there is no time for palliative care at that point. I wonder if quality of life ever comes into the picture for them. I think this is because of their own fears of failure and of death.
- Posted by Kathy 8/29/10 5:43 PM
Palliative care is intended to assist in management of complex medical cases and to do all that can be done to ensure the patient's comfort. When combined with appropriate care of the disease, as it was in this study, patients do better - they suffered less depression, less untreated pain and, most significantly, lived longer than those patients who did not choose to receive palliative care.
As a caregiver, my burdens were eased by the personally attuned, comprehensive care provided by a palliative care physician, who also consulted regularly and effectively with my wife's oncologist. My wife died in the familiar surroundings of our home under the care of my daughter and me as well as visiting hospice. It was the best route for both the patient and the family.
We need more and better studies of palliative care but I believe simultaneous medical and palliative care will be proven superior to medical care alone for most patients.
- Posted by George Schwartz 8/31/10 11:28 AM
As a former oncology nurse, I sensed the physicians who utilized aggressive therapies did so as a palliative measure for themselves as they were in denial about the impending outcome. A physician's charge is to 'heal the sick'. When it was apparent that would not happen, the physicians were acutely aggressive with therapies. It never changed the outcome...death for the patient, and guilt for the physician. For many patients and families, it prolonged pain and suffering. Some oncologists/hematologists were comfortable in dealing with the inevitable, and provided palliative care and emotional support.
I am a survivor of two primary cancers...breast and kidney. It heartens me to know palliative care is available at the academic center where I am treated. I will not hesitate to seek it should the need arise. It saddens me, however, that the uneducated consumer may not have the wherewith all to reach this decision because of lack of information. (Uneducated in my definition is to not have the necessary knowledge in the field to ask appropriate questions and make decisions.) Patient advocates are one solution acting as liaisons to fill that need. However, they are an exception. Until this and other alternatives are the norm, patients and families will continue to suffer as information about options about palliative care is not fully available to them.
- Posted by Rebecca Work 9/2/10 11:35 PM
I have live with breast cancer for 15 years, 8 of them Stage IV. I guess you would put me in your chronic category. There is no way I am surviving all the treatments I am surviving without palliative care. This includes 4 years of treatments for brain mets. I have not had a doctor to manage this for me; but my oncologist and family doctor have been very willing to work with me to alleviate side affects, especially managing pain, menopause, ansd severe allergic reactions. This has included at times some unorthodox alternative things that I investigate and find as well as a willingness on my oncologist's part to send me to allergists and other specialists as needed for relief. But it is because of my persistance that this occurs. I wish there was one person coordinating all of this and keeping up with all of the different things I have tried over the years. I am sure no one keeps track of the treatments I use that are OTC that really relieve symptoms (especially since I am a bargain shopper as well and always look for the least costly alternatives). I am glad I am able to do this; when I am no longer able to do it, I hope my husband is trained well enough to carry on for me. Meanwhile, I will carry on, and hope I can last long enough for the cure we are all waiting for to finally arrive before I lose too much of my brain to keep doing this!!!
- Posted by Stephanie Augspurger 9/3/10 12:43 PM