What Is Palliative Care?
Quality of Life continued...
Like Huggins, people who face serious illness often need emotional and spiritual support.
Beverly, a 55-year-old San Francisco Bay Area woman who requested that her last name be withheld, was diagnosed with bladder cancer at age 37 and has had multiple recurrences. She felt outraged, as she worried that her illness might have been preventable; she believes it may have stemmed from textile dyes that she had used frequently without knowing of their cancer-causing potential.
She resents the pressure to be an upbeat cancer warrior.
"[Cancer] is not a gift. This is the worst thing that's ever happened to me," Beverly says.
Her family and friends urged her to be positive. But when a social worker allowed her to vent her anger, she began to cope with her powerful emotions. "I felt that compassion from her. I got to be a whole person in her eyes," Beverly says.
Palliative care is holistic. For patients, this means attending to the challenges that illness poses in every aspect of life. It also means that palliative care extends to family members and caregivers. Support services may include:
- educating family members about the patient's illness, treatment, and medications
- respite care for caregivers
- home help with transportation, meals, and shopping.
But flexibility is important. Meier recalls one patient, a 24-year-old woman who developed acute leukemia. She had intense bone pain, severe shortness of breath, panic attacks, anxiety, and a large, devastated family with one sibling who was a substance abuser. As a result, nobody in the family wanted her to have any pain medicine.
"You get this sense of how complex and intense the palliative care needs were for this young woman," Meier says. "Frankly, I don't think she would have gotten through her treatment at all had she not had expert treatment of her pain, her shortness of breath, her anxiety, and a tremendous amount of counseling and support for her family."
When faced with serious illness, some patients yearn for reconciliation with an estranged spouse or child, Chan says. Social workers will attempt to contact the person at the patient's request.
Is Palliative Care Effective?
With all of its emphasis on the whole person -- even one's family and relationships -- does palliative care truly improve quality of life?
In a study published in August 2010 in the New England Journal of Medicine, researchers at Massachusetts General Hospital found that advanced lung cancer patients who received early palliative care actually had lower rates of depression and better quality of life than patients who received standard treatment only.
The study of 151 patients, who were randomly assigned to get standard lung cancer care alone or to get standard care and palliative care at the same time, also yielded a surprise: The palliative care patients tended to live about 2.7 months longer. This may have been due to more effective treatment of depression, better management of symptoms, or less need for hospitalization.
For a patient with advanced lung cancer, that extra time is significant.
"If we had a new chemotherapy agent that added three months to the life of lung cancer patients, everyone would be running to invest," Meier says. "I think the important thing for the public to understand is that suffering is actually bad for your health."