Cancer has a significant impact on society in India and globally. Its incidence has been steadily increasing over the past decade, and future reports indicate that it will continue to increase. A large proportion of cancer deaths are due to late detection of cancer and ignorance of the disease by the public. It is a disease in which a part of the body's cells grows out of control and metastasizes—spreading to other areas of the body.
There are numerous treatment options available for cancer; the kind and stage of your disease will dictate the course of your care. There might be just one treatment available for certain cancer patients. But in addition to surgery, the majority of patients receive a mix of therapies, such as radiation and/or chemotherapy. These days, targeted therapy, hormone therapy, and immunotherapy are also involved in some cancer situations.
Oncologists are often involved in the complex care of patients, and with emerging new trends and new therapies nowadays, there is an increase in overall patient survival. Due to the possibility of difficult and protracted patient and caregiver discomfort, these modifications to the cancer's trajectory have increased the patient's need for appropriate symptom management and supportive care.
In the evolving field of oncology, Palliative Medicine is increasingly recognized as a core component of cancer care, with a growing imperative role in managing sources of patient distress and improving patient quality of life (QOL). The term Palliative Care is derived from the Greek word pallium, which means to relieve pain, and when combined with the English word care, it becomes Palliative Care, which specifically focuses on relief of total pain.
In simple words, Palliative Care is a branch of Medicine that provides specialized care to people living with chronic serious life limiting illnesses like cancer and focuses on alleviating the symptom burden and improving QOL. It is appropriate for patients of any age group and can be provided at every stage of serious illness. Ideally, Palliative Care should be provided concurrently in an integrated fashion, along with disease-directed treatments like chemotherapy, radiation, or surgery.
A clinical practice guideline from the American Society of Clinical Oncology (ASCO) recommends that all patients with advanced cancer should receive Palliative Care early, alongside active treatment. This recognition emphasizes the importance of addressing distressing symptoms like pain, nausea, vomiting, swellings, breathlessness, constipation, infections, diarrhoea, loss of appetite, etc., understanding of illness, goals of care, and decision-making as part of standard care.
Some of the studies showed that incorporating Palliative Care early in cancer treatment improves the quality of life of patients by providing better symptom control thus reducing psychological/spiritual/social suffering. These benefits have led to a global consensus supporting the integration of Palliative Care into routine cancer practice.
Palliative Care can make the following changes in the lives of any cancer patient, especially those suffering from advanced progressive cancer.
- Relief of pain is of prime importance that is done by way of trustworthy communication, using the World Health Organization analgesic ladder, and performing minimally invasive pain and spine interventions (MIPSI) using X-ray or ultrasound guidance. This definitely enhances the functional capacity of the patient and in turn improves compliance with treatment.
- Recognizing that all chronic life limiting diseases exhibit an iceberg phenomenon. Palliative Care promises not only to take care of the physical pain (referring to the tip of the iceberg), but it also includes healing the pain deep within the heart—the psychological, emotional, social, and spiritual burden (the part of the iceberg beneath the surface). With each visit, the Palliative Care team provides counselling support as well as build rapport with families to help ease the untold burden.
- For a medical branch that primarily deals with life-limiting diseases like cancer, a good EOLC (end of life care) or hospice care program is essential. Patients and their caregivers should be informed and educated about anticipated events in their disease trajectory and, most importantly, provide awareness regarding the most important concept of "good death" – living well and leaving well.
- Goals of care and answers to difficult questions, especially for patients who are near the end of life or are not able to perform self-care and suffering from complex refractory symptoms, are also considered essential.
The American Society of Clinical Oncology (ASCO) published a recommendation in February 2017 stating that all patients with advanced cancer (those with metastasis, late-stage cancer, and/or a prognosis of 24 months or less) should start getting Palliative Care within eight weeks of diagnosis and concurrently with active treatment in both inpatient and outpatient settings.
This is associated with higher rates of satisfaction among patients and their families with their medical care, a smoother transition to end-of-life care, and a reduction in the family’s feelings of fear, rage, and denial about the impending death of a loved one.
Palliative Care serves as a new pillar of comprehensive oncology alongside curative treatment, prevention, and early detection. Therefore, by integrating palliative care into oncology, we can enhance patient outcomes and reduce healthcare costs by good pain relief, managing the symptom burden and providing psychological/social/spiritual/emotional support.