Palliative Care

Palliative care, sometimes also called supportive care, is given to a patient who has a serious or life-threatening disease.

The goal of palliative care is to prevent or treat the symptoms and side effects of the disease and its treatment. At the same time, it addresses the emotional, social, practical, and spiritual problems that a patient faces.

The goal of palliative care is not to cure the disease, but to improve the patient’s quality of lifeThe overall enjoyment of life; an individual’s sense of well-being and ability to carry out various activities while he or she is receiving standard medical care by anticipating, preventing, and treating suffering. Palliative care can be provided from the time of diagnosis, throughout treatment, and at the end of life.1,2

Who should receive palliative care?

Any person who suffers from pain, stress, or other symptoms due to a serious illness, such as lung cancer, should receive palliative care.

The American Society of Clinical Oncology (ASCO) recommends that all patients with advanced cancer receive palliative care early on and concurrent with cancer treatment.3

How are patients referred for palliative care?

Usually the primary care physician or specialist managing the illness will make the referral to a board-certified palliative care specialist. A hospital social worker can also help patients and their families select a palliative care provider. While many insurance plans as well as Medicare and Medicaid cover at least some palliative care services, patients should discuss what services are provided with their insurer in advance. Patients without health insurance should check with a social worker or their hospital's financial counselor.1

Who provides palliative care?

Palliative care can be provided in a doctor’s office, hospital, cancer center, long-term care facility, or the patient's home. Social workers and patient navigatorsSomeone who provides personal guidance to patients as they move through the health care system can help with many of the emotional and practical issues. In addition, some physicians and advanced practice nurses specialize in palliative care. Many large hospitals and cancer centers have teams of palliative care doctors, nurses, social workers, therapists, and chaplains who work together to provide care alongside the oncologist. If the hospital or outpatient facility does not have a palliative care team, an oncologistA doctor who specializes in treating cancer can refer a patient to a palliative care physician outside the facility. (Note that a palliative care specialist never replaces an oncologist.) 1,3,4

What specific problems can palliative care address?

The diagnosis of lung cancer and its treatment affect all areas of a patient’s and family’s life. The palliative care team is able to focus on these effects.1,3,4

Physical symptoms or side effects

  • Pain
  • Trouble sleeping
  • Shortness of breath
  • Nausea, loss of appetite

Palliative care treatments may include:

  • Medicine (pain relievers, chemotherapyTreatment with drugs that kill cancer cells to decrease the size of a tumorAn abnormal mass of tissue that results when cells divide more than they should or do not die when they should)
  • Other medical treatments (radiationThe use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors or surgery to decrease the size of a tumor)
  • Nutrition
  • Physical therapy
  • Complementary therapies (massage, guided imagery, acupuncture)

Emotional problems

  • Stress of the illness leading to fear, anxiety, hopelessness, or depression
  • Helping caregivers balance their roles and duties and find support

Palliative care treatments may include:

  • Counseling
  • Support groups
  • Family meetings
  • Referrals to mental health providers

Practical problems

  • Money or employment difficulties
  • Child care worries
  • Insurance questions
  • Legal issues

The palliative care team may:

  • Explain complex medical forms
  • Help patients and families understand diagnosis and treatment choices
  • Refer families to financial counseling and financial assistance resources
  • Help connect patients and families to resources for transportation, housing, and other community resources

Spiritual issues

  • Looking for meaning in life
  • Questioning one's faith

The palliative care team may:

  • Help patients and families explore their beliefs and values so they can find peace or move toward acceptance

What effect can palliative care have?

Research has shown that starting palliative care at the time that advanced cancer is diagnosed leads to:

  • Better quality of life
  • Lower rates of depression
  • Improvement in patients’ understanding of their prognosisThe likely outcome or course of a disease; the chance of recovery or recurrence
  • Better clarification in treatment preferences and goals of care
  • Decrease in acute care services (emergency department visits and hospital admissions)
  • Improvement in survival5,6

What is the difference between palliative care and hospice care?

Although these terms are often used in similar ways, they are somewhat different.

  • Palliative care can be provided at every step of the treatment process and at all stages of illness. It is an extra layer of support that can be initiated alongside other standard medical care for patients with serious illnesses, to make them as comfortable as possible.
  • Hospice care is a form of palliative care given to people with a terminal illness, such as cancer, who have a life expectancy of six months or less. If a person chooses to make the transition to hospice care, palliative care specialists will help with the transition and address the physical and emotional issues that come with that choice.1,3,5

Questions to ask your healthcare team about palliative care

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  1. What are your goals for palliative care for me?
  2. What palliative care treatment(s) will I be getting?
  3. Will these be combined with treatments for my lung cancer?
  4. Where will I receive palliative care?
  5. How long will I receive care?
  6. Who will be my palliative care providers?
  7. How much will my palliative care cost?
  8. Are all of these costs covered by my insurance?

Updated January 3, 2018


References

  1. Palliative Care in Cancer. National Cancer Institute website. www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet. Reviewed March 16, 2016. Accessed November 30, 2017.
  2. Temel JS, Greer JA, Muzikansky A, et al. Early Palliative Care for Patients with Metastatic Non-Small Lung Cancer. N Engl J Med, 2010; 363-733-742. doi: 10.1056/NEJMoa1000678. http://www.nejm.org/doi/full/10.1056/NEJMoa1000678. Accessed November 30, 2017.
  3. ASCOanswers: Palliative Care. Cancer.Net website. https://www.cancer.net/sites/cancer.net/files/palliative_care.pdf. Published 2017. Accessed November 30, 2017.
  4. Eti S. Palliative care: an evolving field in medicine. Primary Care: Clinics in Office Practice, 2011: 38:159-171. https://www.primarycare.theclinics.com/article/S0095-4543(11)00014-5/pdf.
  5. Parikh RB, Kirch RA, Smith TJ, et al. Early Specialty Palliative Care — Translating Data in Oncology into Practice. N Engl J Med 2013; 369(24):2347-2351. doi: 10.101056/NEJMsb1305469. http://www.nejm.org/doi/full/10.1056/NEJMsb1305469. Accessed November 30, 2017.
  6.  Howie L, Peppercorn J. Early palliative care in cancer treatment: rationale, evidence and clinical implications. Ther Adv Med Oncol. 2013 Nov; 5(6): 318-323. doi: 10.10.1177/1758834013500375. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3799294.  Accessed November 30, 2017.

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