An excerpt from Cancer What You Need to Know.
Treating cancer means taking care of the whole patient — the physical, the emotional, and the spiritual. This starts at diagnosis and carries through treatment and beyond.
Unfortunately, for some patients, cancer does find ways to spread that can cause physical pain, emotional strain, and difficulties in dealing with end-of-life issues. Palliative care and hospice providers are experts in helping people deal with these difficult times. These providers are an important part of the cancer care team.
What is palliative care?
People are often petrified of the terms palliative care and hospice. Palliative care providers form part of a patient’s care team. One of the biggest mistakes patients make is failing to get palliative care and hospice doctors involved in their care early on.
Palliative care is a specialty that provides specialized medical care to help relieve pain, stress, and symptoms from an illness. These providers can and should be part of the medical team! They work with patients with all types of significant medical challenges, such as heart failure, but they play a key role for cancer patients.
Dealing with physical and emotional pain
Cancer and its treatment may cause pain or difficulty during normal activities. Medical oncologists, radiation oncologists, and surgeons are experts in dealing with pain and other side effects of cancer. Sometimes pain and other symptoms don’t respond to our normal tricks or medications. That’s where palliative care providers can help. They’re clinicians with extra special training in dealing with these issues.
Emotional pain is often ignored in dealing with cancer (see Chapter 4). Palliative care specialists receive training to help with the emotional aspects of grave illness, too. They work well with counselors, psychologists, social workers, and psychiatrists.
What is hospice care?
Many palliative care providers also work in hospice care. Hospice is end-of-life care—it’s to support the patient, family, and loved ones as they face an advanced illness.
All medical care should emphasize quality of life, but hospice care takes this idea to the extreme. Active treatment is no longer given if it could artificially prolong suffering. The goal is for the patient to live well with minimal suffering.
Patients enter hospice when they likely have less than six months to live. The care can take place in a facility or at home.
There are many misconceptions about hospice care that I hope to clear up. Entering hospice doesn’t mean that a patient will be stuck there! If a patient shows dramatic improvement, they can leave hospice care as well.
Active cancer treatment is generally not allowed while a patient is in hospice. Some hospice programs allow patients to receive radiation to decrease pain or other palliative treatments. Other hospice services need the patient to come off of hospice to get treated, and then patients re-enroll. For most patients, this isn’t a big deal, as you can come off and on hospice.
Hospice is not giving up on the patient; it’s supporting the patient in their journey of life and beyond. Just because a patient enters hospice doesn’t mean that other providers don’t want to be involved in their care. Doctors, nurses, and the medical and emotional teams will follow along with the patient through hospice and end of life.
The transition to hospice is an emotional one. Both the medical and emotional teams can help patients and families make the transition.
Early involvement, better outcomes
Again, involving palliative care and hospice care doctors is not giving up on a patient; it’s just taking care of the person as a whole.
Patients often wait to make palliative care treatment part of their cancer care. When things have gotten out of control—the pain is unbearable or they’re struggling emotionally—then they ask for a palliative care consultation. There’s no reason to wait!
Studies show that involving palliative care clinicians early improves outcomes for gravely ill patients. This includes improved survival, shorter hospital stays, fewer ER visits, and improvements in the quality of care.
Palliative care doctors often help with end-of-life issues, but that’s only a fraction of what they do. They’re incredible people who have a lot to offer. Don’t be afraid to ask your medical team for a palliative care referral!
Similarly, the early involvement of hospice benefits patients. Studies show that when patients get hospice care involved early, they tend to live longer and have a better quality of life. Many patients and families don’t get hospice care involved until late in treatment, often out of fear. It’s the next common mistake that patients and families make.
All cancer care needs to consider the whole patient.
Stephen Rosenberg is a radiation oncologist and author of Cancer What You Need to Know.
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