Last Days of Life (PDQ®): Supportive care - Health Professional Information [NCI] - Overview
In a cross-sectional study of parents who lost a child to cancer, clear discussions between the primary oncologist and the parents were more likely to be associated with planning for the location of death, fewer hospital admissions, and parents feeling more prepared for the child's end of life.
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. 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.
Inpatient palliative care services are increasingly available in hospitals with more than 50 beds; between 2000 and 2011, the prevalence increased from 24% to 67%. 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 is a specialized form of interdisciplinary 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).