Palliative Care

Abstract

Palliative care is comprehensive care focused on alleviating suffering and maximizing quality of life for patients with life-threatening illness, including cancer. Achieving these goals requires careful pain and symptom management, psychosocial and spiritual support of patients and families, and understanding of patient and family preferences and goals. Palliative care was once viewed as relevant mainly for patients very near death; however, newer models of palliative care (Fig. 24–1) highlight its role along the continuum of care from diagnosis until death. Oncologists must develop skills in providing excellent palliative care from the time of diagnosis through all phases of a patient’s illness. Specific times to address the goals of palliation include when bad news is conveyed (eg, when disease progresses, when therapeutic options are limited or when cure is not possible); times of increased symptomatology (eg, when chemotherapy is given or when disease progression leads to further symptoms); and times of increased family stress (eg, when decisions regarding end-of-life care must be made). Oncologists need to recognize and respond to these transition points in a patient’s care. One of the most difficult transitions is when the focus of care shifts from disease-oriented, anticancer therapy to symptom-oriented palliative care. Helping patients and families recognize this transition point requires the accurate assessment of their understanding of the diagnosis and prognosis; effectively communicating details of the illness including likely disease course and outcomes, and potential benefits and burdens of available treatment options (including palliative care). A multidisciplinary team including physicians, nurses, social workers, chaplains, and psychologists can most effectively meet the diverse physical, psychosocial, spiritual, financial, and practical needs of patients and families facing a life-threatening illness.