Oncological and Terminal Palliative Care

Palliative care is a rapidly growing subspecialty of medicine entailing expert and active assessment, evaluation and treatment of the physical, psychological, social and spiritual needs of patients and families with serious illnesses. It provides an added layer of support to the patient's regular medical care. As cancer is detected earlier and its treatments improve, palliative care and nursing is increasingly playing a vital role in the oncology population. Because of these advances in oncology, the role of palliative care services for such patients is actively evolving. Herein, we will highlight emerging paradigms in palliative care and attempt to delineate key education, research and policy areas that lie ahead for the field of palliative oncology. Despite the critical need for improving multi-faceted and multi-specialty symptom management and patient–physician communication, we will focus on the interface between palliative care and oncology specialists, a relationship that can lead to better overall patient care on all of these levels. Oncologists hold different notions and continue to receive mixed messages regarding the scope of palliative care. This phenomenon reflects a rapidly changing healthcare landscape, necessitating continual palliative care education and provider self-assessment in order to deliver the highest quality care to patients with serious illnesses.

At its origins, palliative care was defined in 1990, by the World Health Organization (WHO) as ‘the active total care of patients whose disease is not responsive to curative treatments’. While the definition further stated that ‘many aspects of palliative care are also applicable earlier in the course of the illness, palliative nursing was initially conceptualized as a specialty to care for end-stage and dying cancer patients. Over the past two decades, in response to the needs of patients living with serious illness for multiple years, the transformation of many cancers into chronic diseases through treatment advances, and the recognition that patients cannot be segmented into those who are living and those who are dying, the definition and role palliative care has evolved and changed. Indeed, in 2012, palliative care is defined as specialized medical care for people with serious illnesses. This kind of care is centered around giving patients alleviation from the side effects, torment, and worry of a genuine disease, whatever the determination. The objective is to enhance personal satisfaction for both the patient and the family. Palliative care is given by a group of specialists, medical attendants, and different authorities who work with a patient's different specialists to give an additional layer of help. This present definition is remarkable for its absence of any say of 'cure'. While patients receiving palliative care can transition into hospice and end-of-life care, the goal of palliative care is to optimize quality of life while living with a serious illness. Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment. Recent perspectives from leaders in oncology and palliative care agree with this notion of co-management, regardless of curability. Alongside recent progress run many obstacles for moving palliative care of the cancer patient forward, as well as an ever-growing cadre of complex patient needs. Cancer care has transformed many of the disease states under the purview of the medical oncologist into a chronic illness. In 2007, upwards of 12 million patients were alive in the US with cancer a dramatic increase from 3 million in 1971. As the number of US citizens with multiple co-morbidities is estimated to swell to 81 million in 2020, cancer survivors will also be grappling with competing illnesses. Accordingly, cancer patients presenting to palliative medicine specialists on average report greater than ten symptoms, and suffer from progressively worse quality of life. The majority of cancer patients want information about their prognosis and options for care, prefer to spend time at home and out of hospitals, desire palliative care, and hope to die at home. However, recent evidence demonstrates that the majority of patients, including those with cancer, report inadequate discussions with their physicians regarding goals of care and prognosis, and poor satisfaction with multiple areas of communication in the setting of serious illness. Finally, upwards of 30% of Medicare beneficiaries with cancer die in the hospital, not infrequently with intensive care and chemotherapy services in that last month of life. Reimbursement reform, access to palliative care and improvements in patient–physician communication are necessary in order to address these deficiencies.

  • Life Prolonging Care
  • Post-Life Care
  • Disease Directed Care
  • Bereavement Techniques

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