Cancer: Palliative Care and Quality of Life
How Palliative Care Can Help
Fortunately, there’s plenty that palliative care specialists can offer.
- For shortness of breath, doctors can prescribe medications that open up air
passages or they can give patients extra oxygen. Sometimes simply changing
position in bed is enough to ease breathing difficulties.
- Nausea, which is a common side effect of some chemotherapy drugs, can be
alleviated with medications.
- Loss of appetite, another common side effect, can be addressed with dietary
changes and a schedule of eating several small meals during the day.
Palliative Care Takes a Holistic Approach
In many ways, palliative care builds on the model of holistic medicine,
which was developed to treat not just a disease but the person experiencing it.
“Oncologists treat cancer as a physical process,” Bruera says. “Palliative
medicine addresses all the components of the illness.”
A growing number of programs combine conventional treatments with
complementary approaches -- meditation, acupuncture, and massage therapy, for
Treating cancer and managing side effects and symptoms can be complicated.
It’s natural to feel depressed when you’re fighting cancer, for example.
Talking to a counselor can help. But depression may also be a sign that pain
isn’t being adequately controlled. For that, doctors may need to prescribe
opioid drugs. These are very effective, but they also have side effects. One
common problem, constipation, may be treated with laxatives.
How to Find Good Palliative Care
The best way to ensure good palliative care is to find a cancer center that
offers a comprehensive program of support. That’s not always easy. Although
many centers have such programs, Bruera says, “most are inpatient programs, so
they’re only available to patients who are admitted to the hospital. That
typically means patients who are already quite ill.”
But thanks to earlier diagnosis and better treatments, “cancer is now
largely an out-patient disease,” Bruera says. Acknowledging that fact, M.D.
Anderson Cancer Center and other cancer centers have created pilot outpatient
palliative care programs. Early evidence suggests that such centers help
improve quality of life for patients at all stages.
How to Build Your Own Palliative Care Team
If your medical center doesn’t offer a palliative care program, talk to your
oncologist about putting together an informal team of people that offer help.
The list should include an expert in pain management and a social worker or
counselor, along with your oncologist. Seek spiritual support from any
religious group with which you are affiliated.
Even when good palliative care is available, it’s important to be assertive.
If you are in pain, for example, speak up. “Many cancer patients are still
reluctant to say they’re in pain for fear of appearing weak,” says David
Casarett, MD, associate professor of geriatrics at the University of
Pennsylvania, who specializes in palliative medicine. “Pain can be managed
effectively, but only when we know a patient is in pain.”