Q & A: Palliative Care Helpful Along the Journey

CURE, Winter 2010, Volume 9, Issue 4

A study highlights the need for palliative care.

Q: Can palliative care help treat cancer symptoms?

A: A recent paper in The New England Journal of Medicine should remind us that, just because we have all sorts of drugs and other treatments available for cancer patients, doesn’t mean we should ignore the more human side of our care.

The research was intended to find out whether early intervention with palliative care teams at the beginning of cancer treatment for advanced lung cancer had any benefit, compared with more standard care. Both groups of patients had the opportunity to receive standard chemotherapy as part of their treatment program. The patients who were in the experimental group were offered consultations with palliative care specialists early in their course while those in the control group could receive palliative care consultations when and if they thought appropriate.

The results were fascinating. The patients who received early palliative care had a better quality of life and less depression than those who did not. For me, the most unexpected finding was that patients who were in the early palliative care group actually lived significantly longer than those in the traditional care group, 11.6 months as opposed to 8.9 months. My thought is that, if this were a drug trial, we would be proclaiming its benefits to everyone.

There is a lot we have learned about the treatment of cancer over the past number of decades. We have better and more complicated forms of chemotherapy. We have better surgical techniques and fancier machines that help us do that surgery. We now have proton beam machines that can exquisitely focus a cancer-killing beam of radiation.

But I am not as certain that most physicians (and perhaps patients and their families as well) have as thoroughly embraced the concept of palliative care and what it can mean for the well-being of patients going through their cancer journey. We love technology, but somehow lose humanity in the process.

Even the term “palliative care” is viewed by some as problematic. For many, the words “palliative care” are used interchangeably with “end-of-life care.” End-of-life care may well be palliative care, but not all palliative care is end-of-life care.

Managing symptoms is not admitting defeat. In fact, as noted in this study, it is a measure of success. Patients who received the benefits of palliative care early in their treatment actually lived longer, suggesting a successful intervention. So, this is not part of an “end game.” Palliative care can very much be a part of a “beginning game.”

What should you do if you or someone you love has been diagnosed with cancer and is undergoing debilitating therapy or has significant symptoms related to cancer? Ask your oncology team if palliative care services are available at your hospital or in your community. And, if they are, get a consult—no matter what point you are in your treatment, even if it is early on.

—Len Lichtenfeld, MD, is deputy chief medical officer for the American Cancer Society.