Palliative Care or Supportive Care

Comfort, care and support for living with dignity right up until the end.

  1. What is ‘Palliative Care’ or ‘Supportive Care’ for cancer patients?
  2. ‘Palliative Care’ and life expectancy for cancer patients
  3. Why ‘Palliative Care’ or ‘Supportive Care’?
  4. Quality of life
  5. Fear and anxiety when referred
  6. Complementary therapies for advanced cancer patients

Estimated read-time: 7 minutes

What is ‘Palliative Care’ or ‘Supportive Care’ for cancer patients?

Palliative Care or increasingly called ‘Supportive Care’ plays a crucial role in the modern comprehensive cancer care of today.1 In the fight against cancer, the first medical intervention you receive aims to cure the disease and help ease any symptoms of the disease and side effects from the treatment you may experience.2 When a cure is no longer possible, Palliative or Supportive Care aims at treating the patient and their family with dignity and respect in the days, months or even in certain cases, years over the course of treatment.

‘Palliative Care’ and life expectancy for cancer patients

Being referred to Palliative Care or Supportive Care does not automatically mean death is near. Some of the support services offered can and should be accessed alongside treatment aiming to cure such as surgery or chemotherapy3,4. It provides a whole-person support and is not reserved solely for patients facing a terminal decline. An emphasis is placed upon supporting the patients’ symptom and side effects along with managing the emotional rollercoaster the patient and their caregiver are on. Worldwide, over a third of adults needing palliative care are cancer patients and this number is expected to rise in-line with an aging population.5

Palliative or Supportive Cancer Care

Why ‘Palliative Care’ or ‘Supportive Care’?

The overarching aim of Palliative Care is to improve quality of life either at home or in a hospice setting. The main areas of support needed at this stage of life include;

  • physical side effects
  • emotional and psychological problems
  • spiritual issues
  • social difficulties
  • managing the strain on the caregiver and family6
  • stress management
  • financial concerns.7

The goal will be to identify promptly8 and even pre-empt9 any concerning issues which both the patient and the immediate family are living with through during this distressing time.10 The Palliative or Supportive Care teams can also provide knowledge and offer support with medical, shared decision-making11 and advice on how to have difficult conversations at the end of life.

Support can be given to enable the patient and their caregiver to slowly come to terms with the patient’s prognosis. This can be achieved in a life-affirming and empathetic way which acknowledges death as a normal and natural process at the end of life.12 Being surrounded by a supportive, understanding Palliative or Supportive Care Team as the emotional, human drama of dying plays out is comforting in the extreme.

The time left before death is so precious for everyone involved and to have that moment of friendship, kindness, understanding13 and strength reach out to you through the darkness is a very special source of reassurance. To have someone outside the family and your circle of friends who understands all that you are going through and can offer support, in a safe environment, free from the heightened emotions and tension feltis crucial in supporting the mental wellbeing of both the patient and their caregiver through this intense time.

It is not advisable to neglect your mental health and the psychological distress as this can lead to you becoming withdrawn to the point that you are no longer able to physically or mentally function, make decisions or have the will to live.14

Quality of life

Maintaining the patient’s physical quality of life is a priority. Being able to live actively, to be able to interact with family and friends, along with being comfortable whilst living with the common symptoms and side effects advanced cancer patients experience is the challenge set.15

In late stage cancer patients these issues tend to be complex to manage and treat as the patient often presents with a ‘cluster’ of many symptoms and side effects.16 Such physical issues suffered can cover a broad range from;

  • pain
  • fatigue
  • nausea and vomiting
  • breathlessness
  • insomnia
  • problems eating
  • weight loss
  • constipation and diarrhea.17

However, relief from physical suffering means that a patient can continue to live as well as they can and enjoy as much as they can, as free as possible from the trials they face.18

Fear and anxiety when referred

The relationship you have with the Palliative Care Team is a difficult one. You can be referred long before you have had a chance to mentally process or even have begun to accept the situation. A milestone is marked19 as many directly associate the help Palliative Care can offer with the end of life, which leads you to feeling out of control and resentful that this is happening.

Your barriers can then be put up as you resist any help, even though you know it will be beneficial. If this negative perception lingers, often the experience will be affected20 and the aim of the support becomes compromised.

However, the objective of Palliative Care is to improve your quality of life and does not necessarily mean that you are at the end of your life. There may come a time when you cannot deny the help offered by the Palliative Care Team with the day to day practicalities of living.

There are many areas of day-to-day life which Palliative or Supportive Care can get help you with, for example;

  • giving specific medication or injections
  • getting dressed
  • washing
  • food preparation
  • maintaining a home
  • sorting out your finances.

It is hugely helpful to get support with these additional burdens which are challenging when energy is low, with the effects of the disease and treatment are weighing heavy upon you.21 Most of the palliative care is carried out in the community and in the patient’s home. This support can take place in several settings for example; in a hospice, a hospital cancer centre as an in-patient or out-patient or even in a residential care home.22

A notable benefit of accessing the support available to you is that it can ease the sense of abandonment you may feel when treatment ends23 and the earlier you can access the help, the more supported you and your caregiver will be.24 This idea is reflected in the promotion of the timely use of these services by researchers in this field in recent years.25

In receiving the combined support from the Oncology and Palliative Care teams you are more likely to stop harsh treatments and interventions sooner, along with a quicker admission into hospice care with the aim of avoiding a death in the intensive care unit. This improvement to a patient’s overall quality of life due to much fewer medical interventions can mean a that the length of survival is improved.26,27

Complementary therapies for advanced cancer patients

For many patients with advanced cancer, relief from the physical and emotional stress they experience can come from the use of integrative medicine and complementary therapies alongside any conventional medical interventions being received.

Reflexology and cancer

This relationship between complementary therapies and palliative care plays an important role in modern oncology practice as it places the patient and their quality of life at the heart of the care provided.28 It will often be the Palliative or Supportive Care Team which will promote and use these additional therapies as a means of offering an active, holistic approach to their support.29

The benefits and effectiveness of many complementary therapies, especially over the short-term, widely reported in evidence-based scientific research.30 This has led to an integrated approach being largely supported by both professionals and patients alike.

Patients, especially those who are on their own and have been previously isolated, often enjoy the affection and security which can be experienced by receiving a complementary therapy. Many families and caregivers also find comfort in being able to be involved and share precious moments of closeness by the bedside by perhaps giving the patient a head, hand or foot massage.31

A personalized approach is recommended, can be of benefit depending upon the needs and preferences of the patient.32 Consideration clearly needs to be given as to which complementary therapies are suitable and safe for patients who are in a state of physical and perhaps mental decline.33

Commonly used complementary therapies to support a cancer patient’s mental health, help promote relaxation and improve mood along with supporting the control of symptoms and side effects are therapies such as;

  • soft-touch massage34
  • reflexology
  • aromatherapy
  • guided mediation
  • breathing exercises
  • mindfulness techniques
  • spiritual care
  • acupuncture
  • reiki
  • hypnotherapy
  • music therapy
  • yoga
  • tai chi.

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References

  1. Seminars in Oncology, [Online]. Seminars in Oncology Volume 32, Issue 2, 134-138. Available at: https://www.sciencedirect.com/science/article/pii/S009377540400572X [Accessed 13 December 2018].
  2. Balis F.M. (1998) ‘The Goal of Cancer Treatment.’, Oncologist., 3(4), V [Online]. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10388118 (Accessed: 15th October 2019).
  3. Chimielowski, M. & Territo, B., 2017. Manual of Clinical Oncology. 8th ed. Philadelphia: Wolters Kluwer.
  4. Palma, M.D., Ph. D., D., 2017. Taking Charge of Cancer. 1st ed. Oakland, Canada: New Harbinger.
  5. Busolo et al., D., 2015. Palliative care experiences of adult cancer patients from ethnocultural groups: a qualitative systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, [Online]. 13(1), 99–111. Available at: https://insights.ovid.com/pubmed?pmid=26447011 [Accessed 13 December 2018].
  6. Moorey & Greer, S., 2002. Cognitive Behaviour Therapy for People with Cancer. 2nd ed. Oxford, United Kingdom: Oxford University Press.
  7. Sherman, Dr. D. W., 2018. Reciprocal Suffering: The Need to Improve Family Caregivers’ Quality of Life through Palliative Care. Journal of Palliative Medicine, [Online]. Volume, Issue 4, 357. Available at: https://www.liebertpub.com/doi/abs/10.1089/jpm.1998.1.357 [Accessed 13 December 2018].
  8. Worldwide Palliative Care Alliance, World Health Organization. 2014. Global Atlas of Palliative Care at the End of Life. [ONLINE] Available at: https://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf. [Accessed 13 December 2018].
  9. Abu Dabrh et al., A. M., 2018. Sharing is Caring: Minimizing the Disruption with Palliative Care. Cureus, [Online]. 10(3), e2321. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5947928/ [Accessed 13 December 2018].
  10. Merz et al., T., 2011. Fungating Wounds – Multidimensional Challenge in Palliative Care. Breast Care (Basel), [Online]. 6(1), 21–24. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083267/ [Accessed 13 December 2018].
  11. Frank, R. K. (2013) ‘Shared decision making and its role in end of life care’, British Journal of Nursing, Vol. 18 (No. 10), [Online]. Available at: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2009.18.10.42466 (Accessed: 16th October 2019).
  12. Howard, P. & Chady, B. (2012) Cancer & Palliative Care Nursing, 1st edn., United Kingdom: Balliere Tindall.
  13. Groopman, M. D., J., 1998. The Measure of Our Days. 2nd ed. United States of America: Penguin Books.
  14. Kadan‐Lottick M.D., M.S.P.H. et al., N. S., 2018. Psychiatric disorders and mental health service use in patients with advanced cancer. Cancer, [Online]. Volume 104, Issue 12, 2872-2881. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.21532 [Accessed 13 December 2018].
  15. Lung Foundation Australia. 2018. Overview Lung Cancer. [ONLINE] Available at: https://lungfoundation.com.au/patients-carers/living-with-a-lung-disease/lung-cancer/overview/. [Accessed 13 December 2018].
  16. Carter, A. & Mackereth, Dr. P.A., 2017. Aromatherapy, Massage and Relaxation in Cancer Care. 1st ed. London, UK: Jessica Kingsley Publishers.
  17. Yoo et al., H., 2018. Perceived social support and its impact on depression and health-related quality of life: a comparison between cancer patients and general population. Japanese Journal of Clinical Oncology, [Online]. Volume 47, Issue 8, 728–734. Available at: https://academic.oup.com/jjco/article/47/8/728/3836890 [Accessed 10 December 2018].
  18. Smith, M.D., T. J. et al. (2011) ‘Bending the Cost Curve in Cancer Care’, New England Journal of Medicine, [Online]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042405/(Accessed: 23rd April 2019).
  19. Black, A., Arnold R., & Tulsky J., 2009. Mastering Communication with Seriously Ill Patients. 1st ed. New York, United States: Cambridge University Press.
  20. Busolo et al., D., 2015. Palliative care experiences of adult cancer patients from ethnocultural groups: a qualitative systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, [Online]. 13(1), 99–111. Available at: https://insights.ovid.com/pubmed?pmid=26447011 [Accessed 13 December 2018].
  21. Carter, A. & Mackereth, Dr. P.A., 2017. Aromatherapy, Massage and Relaxation in Cancer Care. 1st ed. London, UK: Jessica Kingsley Publishers.
  22. NICE- National Institute for Clinical Excellence. 2018. Guidance on Cancer Services Improving Supportive and Palliative Care for Adults with Cancer, The Manual National. [ONLINE] Available at: https://www.nice.org.uk/guidance/csg4/resources/improving-supportive-and-palliative-care-for-adults-with-cancer-pdf-773375005. [Accessed 13 December 2018].
  23. Tolbert LCSW, P. & Damaskos LCSW OSWC, P. (2008) 100 Questions & Answers About Life After Cancer: A Survivor’s Guide, 1st edn., United States of America: Jones and Bartlett Publications.
  24. Dalal, S., 2016. Use of Palliative Care Services in a Tertiary Cancer Center. Oncologist, [Online]. 21(1), 110–118. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709207/ [Accessed 13 December 2018.
  25. Lorig, Dr. PH K., Holman , H., MD, Sobel, D., MD, MPH, Laurent, D., MPH, Gonzalez, V. MPH, Minor, M. RPT, PhD (2014) Self-management of Long-term Health Conditions, 1st. edn., United Kingdom: Bull Publishings.
  26. O’Mahony, S., 2017. The Way We Die Now. 1st ed. London, UK: Head of Zeus.
  27. Ben-Arye E., Samuels N., Silbermann M. (2017) ‘Palliative Medicine and Hospice Care’, Palliative Medicine and Hospice Care, 2(2), pp. e7-e10 [Online]. Available at: doi: 10.17140/PMHCOJ-2-e003 (Accessed: 25th August 2019).
  28. Carter, A. & Mackereth, Dr. P.A., 2017. Aromatherapy, Massage and Relaxation in Cancer Care. 1st ed. London, UK: Jessica Kingsley Publishers.
  29. Greer, S. & Joseph, M. (2015) ‘Palliative Care: A Holistic Discipline’, Integrative Cancer Therapies, Volume: 15 (Issue: 1), Page(s): 5-9 [Online]. Available at: https://journals.sagepub.com/doi/full/10.1177/1534735415617015 (Accessed: 16th October 2019).
  30. Zeng, Y. S. et al. (2018) ‘Complementary and Alternative Medicine in Hospice and Palliative Care: A Systematic Review’, Journal of Pain and Symptom Management, Volume 56 (Issue 5), pp. Pages 781–794.e4 [Online]. Available at: https://doi.org/10.1016/j.jpainsymman.2018.07.016 (Accessed: 25th August 2019).
  31. Falkensteiner et al., M., 2011. The Use of Massage Therapy for Reducing Pain, Anxiety, and Depression in Oncological Palliative Care Patients: A Narrative Review of the Literature. ISRN Nursing, [Online]. 2011, 929868. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168862/ [Accessed 17 December 2018].
  32. Yildirim et al., Y. K., 2006. [Complementary therapies in palliative cancer care]. Agri., [Online]. 18(1), 26-32. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16783665 [Accessed 13 December 2018].
  33. Muecke, R. MD (2016) ‘Complementary and Alternative Medicine in Palliative Care ‘, Integrative Cancer Therapy, 15(1), pp. 10–16. [Online]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736076/ (Accessed: 25th August 2019).
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