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Last Days of Life (PDQ®): Supportive care - Health Professional Information [NCI] - Overview

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Palliative Care

Palliative care is an approach that can improve the quality of life for patients and their families facing life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical, psychosocial, and spiritual problems.[5] A randomized controlled study of early integrated palliative care with standard oncologic care versus standard oncologic care alone in patients newly diagnosed with metastatic non-small cell lung cancer revealed improved quality of life, fewer depressive symptoms, and longer median survival despite less aggressive end-of-life care in the group receiving palliative care.[6]

Inpatient palliative care services are increasingly available in hospitals with more than 50 beds; between 2000 and 2010, the prevalence increased from 24.5% to 65.7%.[7] There is also experience with outpatient palliative care clinics and home services. Regardless of the availability of palliative care services, all oncologists and other professionals caring for people with cancer must be proficient in aggressive symptom management and discussions of advance care planning. These activities are optimally conducted with the palliative care team so that both patient and family hear a consistent message and do not feel abandoned by the physician, with whom they have developed a strong bond.

Hospice

Hospice is a specialized form of interdis ciplinary palliative care that alleviates physical, emotional, social, and spiritual discomfort during the last phase of life. Hospice is a program of care provided by an interdisciplinary team designed to keep a patient at home with family and friends. Pain management and symptom management are paramount, along with bereavement and volunteer components. Hospice provides palliative care, with which it is frequently confused; however, the focus of hospice is on patients with life-limiting, progressive disease (usually with a prognosis of no more than 6 months if the disease were to take its natural course).

Utilization of hospice care has increased in the United States, with more than 1.5 million individuals seeking such care. People who had cancer made up approximately 36% of these admissions in 2010.[8] However, a disturbing trend is reflected in the very short median length of stay in hospice of just 19.7 days. This trend suggests that advance care planning is not taking place early in the course of the disease, that the ability of health care providers to prognosticate is poor, and that referrals are made too late; it may also reflect denial on the part of professionals, patients, or their families regarding disease progression. (Refer to the End-of-Life Decisions section of the PDQ summary on Transitional Care Planning for more information.)

References:

  1. Byock I: Dying Well: The Prospect for Growth at the End of Life. New York, NY: Riverhead Books, 1997.
  2. Zhang B, Wright AA, Huskamp HA, et al.: Health care costs in the last week of life: associations with end-of-life conversations. Arch Intern Med 169 (5): 480-8, 2009.
  3. Wright AA, Zhang B, Ray A, et al.: Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300 (14): 1665-73, 2008.
  4. Dussel V, Kreicbergs U, Hilden JM, et al.: Looking beyond where children die: determinants and effects of planning a child's location of death. J Pain Symptom Manage 37 (1): 33-43, 2009.
  5. World Health Organization.: National Cancer Control Programmes: Policies and Managerial Guidelines. 2nd ed. Geneva, Switzerland: World Health Organization, 2002.
  6. Temel JS, Greer JA, Muzikansky A, et al.: Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363 (8): 733-42, 2010.
  7. Center to Advance Palliative Care.: Growth of Palliative Care in U.S. Hospitals: 2012 Snapshot. New York, NY: CAPC, 2012. Available online. Last accessed January 3, 2013.
  8. NHPCO Facts and Figures: Hospice Care in America. 2011 Edition. Alexandria, Va: National Hospice and Palliative Care Organization, 2012. Available online. Last accessed January 3, 2013.
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WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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