A consensus has emerged that palliative care should not be seen as end-of-life care but is best deployed early to help patients and their caregivers manage symptoms throughout the cancer treatment trajectory.
OncLive discussed what this approach means for the future of palliative care with Craig D. Blinderman, director of the Adult Palliative Medicine Service at Columbia University Medical Center/New-York Presbyterian Hospital and co-director of the Center for Supportive Care and Clinical Ethics in the Department of Medicine.
There are a lot of terms used: palliative care, supportive care, hospice. What are the differences among all these terms?
A lot of patients, including physicians, are confused about the terms and sometimes equate palliative care with hospice care. Palliative came out of the oncology literature. Things are either considered curative or palliative when you think about a treatment approach. So palliative became equated with the idea of “I can’t be treated, so I must be going to hospice,” or something like that. And that’s not the case. We’re trying to rebrand the idea that palliative care is an integrative approach to care for patients with serious illnesses like cancer to provide an extra layer of support to them, to their families, to the oncologists and the other treating physicians to manage pain, other symptoms, alleviate suffering, things like that.
Hospice is for patients at the very last stage of life. Typically within the last six months of life. They become eligible for hospice service, which is largely a home care program to keep patients comfortable at the end of life.
Palliative care can be integrated with disease modifying therapies such as chemotherapy, radiation therapy. So we’re trying to consider it more upstream as part of the whole comprehensive care of patients.
It’s true that the term supportive care and palliative care are equated, and in my mind it’s not so problematic. From my perspective, if it works to get patients incorporated into a care plan that includes a palliative care clinician and we call it supportive care, that’s what we’re really trying to do: wrap them with more support—the patients, the family and so forth, and that’s fine.
The program that we have here is under a center called “Supportive Care and Clinical Ethics,” where we work together with the head of ethics to try to provide a program both of education, clinical programming and starting to do some research to really foster this idea that we’re here to support patients, families, and the treating physicians themselves. And convey that we’re trained palliative care clinicians to do that, but it doesn’t matter so much to me if we call it palliative care or supportive care in that sense.
What kind of people should be part of a multidisciplinary team to carry out palliative care to patients?
A trained palliative care physician can’t do this alone. It’s just not possible. Our teams in the hospitals as well as the team that I’m building on the outpatient side includes nursing, nurse practitioners, typically, RNs as well, social workers, chaplains. Some teams will also include people from ethics, psychiatry, psychology, nutrition and so forth.
The center that we’re building here is ultimately going to include nutrition, maybe even some integrative therapy practitioners who provide such services as acupuncture, Reiki, and massage, along with the nurses and social workers.
And why is that important? I think that’s the crucial question because it’s not just giving patients pain medications or treating their nausea. When we think about suffering, suffering is something that the person experiences. And the person is more than just the physical symptoms and physical aspects of his or her body. There are their psychological, emotional states, their social suffering that they might experience, plus existential or spiritual suffering, and all that needs to be understood and assessed and managed. So it’s not appropriate to just have it come from a medically trained person, but to actually have the other components so we can really address all the ways in which patients are suffering through their treatments and to the end of their lives, as it may be.