Howard LeWine, M.D.

As cancer death approaches, palliative care may improve quality of life

Although dying is a fact of life, few people want to think about it. One group that must think about dying are people with advanced cancer who are told they have just a few months to live. What helps them end their days as peacefully as possible?

  • being at home instead of in the hospital
  • not undergoing chemotherapy or other active cancer treatment
  • not having a feeding tube
  • talking with a chaplain or other minister, and spending time in private religious activity
  • having a good relationship with the health-care team
  • not being anxious

Those are the findings from an important survey of almost 400 men and women with advanced cancer who were surveyed an average of four months before dying. Their caregivers were also asked about the person’s end-of-life experience. The study, conducted by researchers with Harvard-affiliated Dana-Farber Cancer Center and Brigham and Women’s Hospital, was published yesterday in the Archives of Internal Medicine.

“What the results suggest is that attention to patients’ psychosocial needs, their spiritual needs, their comfort, their worries, their need to not be abandoned by their health care team and to feel valuable and significant are the things that matter most to the patients and their families,” researcher Holly. G. Prigerson, M.D., told HealthDay. “It’s not . . . how much chemo or what procedures are performed or heroics. In fact, it’s the opposite. It’s the human connection that seemed to be the most important [for] good quality of end-of-life care.”

Quality of life—important at all stages

It can be a challenge to ensure good quality of life at the end of life and a peaceful death. The knowledge that you are dying often provokes intense anxiety and fear, for yourself and your loved ones. Talking through this anxiety and fear with your loved ones, friends, and a minister or other spiritual guide can help.

Doctors can sometimes make things worse, not better. With cancer and virtually every other disease, we want the treatments we’ve recommended to work, and sometimes take it personally when they don’t. Some doctors have a hard time accepting a person’s decision to stop treatment, and may strongly lobby for one more try.

In a commentary on the Archives article, Drs. Alan B. Zonderman and Michelle K. Evans remind doctors what our real mission should be:

The challenge of providing care for patients with advanced cancer lies not in knowing which modalities may offer the best chance for disease response and prolonged survival. The challenge is in physicians’ and other care providers’ abilities to develop and maintain effective integrated relationships with their patients that are strong enough to provide the communication channel to convey the emotionally difficult messages relevant to prognosis, the true efficacy of therapy, the futility of care, and when active palliation is the best treatment modality available.

In other words, we need to make sure we listen very hard to what our patients want, give them the straight truth, and help them make the decisions that are right for them.

Palliative care

When it’s clear that there’s no stopping cancer, heart failure, or other conditions, palliative care can help create a situation that maintains quality of life and leads to a “good death.” Palliative care:

  • Focuses on both emotional and physical needs
  • Makes relief of pain and suffering a top priority
  • Provides active support to loved ones and caregivers, and provides information about how to take care of someone at home

Since a single doctor or nurse usually can’t handle all of these issues, palliative care generally involves a team approach.

If you have advanced cancer, heart failure, or other disease that is likely to end your life, or you are caring for someone with such a condition, talk with a trusted doctor or nurse about palliative care so you are prepared when the time comes. More information about palliative care, and how to get it, is available from the Center to Advance Palliative Care.

Comments:

  1. Easterndrugs

    Hospice and palliative care are often talked about as if they are the same thing, but they’re not. Hospice is for people who are expected to live for a short time (usually defined as six months or less) who have agreed to stop getting treatment aimed at prolonging life. Palliative care is medical care that aims to relieve pain or suffering and, more generally, to improve a person’s quality of life during a serious illness. Palliative care is certainly a major component of hospice care, especially the efforts to relieve pain, but it’s not limited to hospice. People who are actively being treated for a disease can receive palliative care at any stage of their illness.

    Thanks