You may have heard of palliative care being offered to people with advanced cancer and limited prognosis. But did you know its role extends far beyond these scenarios? Modern palliative care can be an integral part of the cancer treatment journey, offering relief and support from the very first diagnosis through all stages of the disease.
In this article, we will explore how palliative care not only helps patients manage the severe side effects of cancer treatments but also provides important support to their caregivers and loved ones.
Table of Contents
What is Palliative Care?
Palliative care focuses on providing relief to symptoms and alleviating suffering through a variety of methods. Its care principles embodies a holistic approach, rather than relying on a single therapy. Another key feature of palliative care is its personalised approach. There is no one-size-fits-all when it comes to palliative care. The care team often works collaboratively with the patient and their family to tailor treatments to the patient’s goals and values.
People with any life-threatening conditions can benefit from palliative care. Cancer is one of the most common situations. According to WHO, 34% of adults who need palliative care suffer from cancer. Pain and breathing difficulties are among the most common and severe symptoms experienced by those requiring palliative care.
Palliative care is not the same as hospice care. The key difference is when each type of care is initiated. Palliative care can be provided at any stage of an illness, offering support from the time of diagnosis onwards. In contrast, hospice care is typically reserved for patients who are expected to have six months or less to live or who have chosen to stop curative treatments. To learn more about the differences between palliative and hospice care and other important aspects of palliation, read our guide to palliative care in Singapore here.
What is Palliative Care for Cancer?
Cancer patients suffer from a multitude of symptoms, some of which may come from cancer itself, some as side effects to the cancer treatments given. The most common physical symptom addressed with palliative care is pain, which is often due to tumour growth or nerve compression. Beyond distressing symptoms, a cancer diagnosis can leave patients and their families feeling overwhelmed and anxious about their future. Your palliative care team can help with not only addressing physical symptoms, but also providing guidance through the complex journey of cancer treatment and emotional support during your challenging moments.
Specifically, palliative care can address the following problems for cancer patients and families:
- Pain
- Shortness of breath or breathlessness (Dyspnea)
- Nausea and vomiting
- Depression, anxiety, and grief
- Physical motion limitations
- Weakness and fatigue
- Spiritual issues
- Practical needs such as financial support, treatment process, home care equipment, etc. (Read more about additional support available during palliative treatment here.)
Palliative Treatment for Cancer
Cancer palliative care may use the same techniques that would treat a tumour in the early stages. In other words, your oncologist in consultation with a palliative specialist may recommend radiation therapy, chemotherapy, and surgery as part of palliative care.
In such cases, palliative treatment may sound the same as standard cancer treatment. However, the difference lies in the treatment goal. When radiation therapy or chemotherapy or surgery is recommended for palliation, these treatments are not to cure cancer, but rather to improve some of the symptoms that patients are dealing with and lower the risks of debilitating complications.
Over the past few years, palliative care for cancer patients has truly developed, which created a new field of treatment known as palliative chemotherapy and palliative radiation therapy.
Palliative Chemotherapy
Differentiating between conventional chemotherapy and palliative chemotherapy can be confusing for cancer patients and their families. As mentioned above, while both treatments use similar medications and techniques, the goal of each approach is different. For the purpose of differentiation, here are some reasons for chemotherapy:
Chemotherapy with curative intent – this refers to using chemotherapy with intent to cure cancer, such as the case of acute leukemias or lung cancer.
Neoadjuvant chemotherapy – your doctor may recommend neoadjuvant chemotherapy before performing surgery to reduce the size of your tumour and lower the risk of spreading before implementing more invasive procedures.
Adjuvant chemotherapy – contrary to neoadjuvant chemotherapy, this treatment is used after surgery. The goal is to get rid of the remaining cancer cells that could travel to distant areas, creating new tumours. Adjuvant chemotherapy reduces the risk of recurrence.
Palliative chemotherapy – palliative chemotherapy does not aim to cure cancer. Instead, it focuses on reducing the size of the tumour and improving clinical symptoms. For instance, if the tumour is pressing on a nerve causing the patient severe pain, palliative chemotherapy may help.
Palliative Radiation Therapy
Similar to palliative chemotherapy, palliative radiation therapy shares the goal of improving symptoms and patients’ quality of life. For example, this type of treatment is suitable for people dealing with severe pain that stems from bone metastasis or spinal cord compression. Palliative radiation therapy may also be recommended to lower the risk of irreversible neurological damage that could lead to paralysis and paresthesia (ie., feelings of pins and needles, most commonly on the limbs).
Radiotherapy utilises external radiation beams to destroy cancer cells. It is a highly targeted therapy that disintegrates the DNA of cancer cells to eradicate them. According to the National Institute of Cancer, 50% of patients diagnosed with cancer will undergo radiation therapy.
A common observation among patients receiving palliative radiation therapy is that symptoms are not relieved immediately. This is because radiation therapy takes time to kill the cancerous cells. In fact, it can take a couple of weeks before DNA is damaged beyond repair for the cells to die. Together with chemotherapy, palliative radiation can significantly improve the patient’s quality of life.
Palliative Targeted Therapy
Targeted therapy refers to the usage of drugs targeting specific elements related to the cancer cells to control their growth and eradicate them. Although many types of targeted therapy have been approved for treatment of various types of cancer such as breast cancer, lung cancer, colorectal cancer, lymphoma, chronic myeloid leukemia (CML), melanoma, etc., much remains to be researched and developed in this field. Therefore, in clinical practice, oncologists may recommend targeted therapy drugs together with chemotherapy.
Similarly, for palliative care, depending on their care goals and their responses to therapy, patients may expect to receive a combination of treatments that include chemotherapy and targeted therapy drugs.
Palliative Hormone Therapy
Hormone therapy is quite common in palliation. Corticosteroid - often known as the ‘stress hormone drug’ - is often used to manage a variety of cancer symptoms such as anti-inflammation for brain cancer, improve appetite for colorectal cancer, relieve fatigue or bone pain. Endocrine therapy (ET) is another known therapy among breast cancer patients.
Other Treatments Used in Palliative Care for Cancer Patients
By far, chemotherapy and radiation therapy are the most prescribed treatments in palliative care. However, your physician may recommend other therapies, depending on your chief complaint.
For instance, if your cancer spreads to your joints, making it difficult to perform certain activities and motions, working with a physical therapist may help you restore the flexibility of your joints. Another example is lung cancer. Some lung cancer patients develop Hodgkin lymphoma, which leads to large lymph nodes in the thorax. Consequently, breathing becomes more challenging, pushing patients to develop serious dyspnea (i.e., shortness of breath). Respiratory therapists specialise in addressing this issue might be recommended to help patients perform certain breathing exercises and regain breathing capacity.
The Composition of your Palliative Care Team
The best way to receive palliative care for cancer patients is by working together in a team effort. The team consists of experts in their respective fields, such as pain specialists and rehabilitation therapy. The cancer patients and their family also form a crucial part of this team.
As cancer patients, by carefully communicating with your palliative care team, you should come up with a comprehensive management plan that takes into account all your signs and symptoms.
Some of the members in the palliative care team working alongside oncologist may include:
- Palliative care physician
- Physiotherapist
- Respiratory therapist
- Nurse
- Social worker
- Chaplain
- Volunteers
Palliative team cooperates closely with your oncologist and other doctors to make the best decisions for your management, according to your care goals and preferences. In Singapore, you can enquire your oncologist for referral to palliative care, or get your independent palliative care service and put them in touch with your cancer doctor.
How Soon and How Often to Receive Palliative Care
Research has shown that it is beneficial to get palliative care early on, ideally at the time of diagnosis or when the symptoms first appear. Palliative care, when combined with standard treatment from an early stage and throughout curative treatment, can improve a patient's quality of life and lessen the intensity of symptoms.
The frequency of palliative care visits can vary, depending on a number of factors, such as symptom intensity, patient response to treatment, personal preferences, and available funding. It is important to note that palliative care is typically not a one-time intervention. In one study published in The Lancet Oncology, scientists found that setting up multiple follow-up consultations to treat cancer patients is significantly more beneficial than a single consultation.
It is advisable for cancer patients and families to discuss palliative care options with your oncologist and a palliative specialist early on. This conversation can help you understand how palliative care can benefit you and explore the available options. While there is no need to commit to palliative care right away, starting these discussions early can help you make more informed decisions. Considerations may include choosing a provider that you are comfortable to work with long-term, and deciding the most suitable setting for care, whether at home, in a specialist clinic, or alongside ongoing cancer treatment at a hospital.
For patients with terminal cancer, palliative care may be recommended by your oncologist or cancer care team. Learn more about palliative care for patients with end-stage cancer in our article discussing palliative care at end-of-life here.
Cancer Care at Home with Ninkatec Palliative Care Team
Modern palliative care can offer significant support at any stages of cancer treatment and for all types of cancer, not just for the person with cancer but also their families. You can count on a palliative care team for support in multiple aspects of your well-being, from easing the symptoms of cancer and the side effects of treatments, to removing barriers that hinder your daily activities and boosting your strength to battle cancer. Your cancer journey is undoubtedly tough, but with the right help and support, the burden can be substantially lightened.
Ninkatec brings together a multidisciplinary team including in-house oncologist and palliative specialist to cater to the needs of all cancer patients. Empowered by 24/7 medical monitoring technology, we bring quality palliative care to your home and stay by your side every step of the way. Find out more about our palliative care services or chat with us about your specific palliative needs and wishes. Ninkatec care team is here to support and guide you through your cancer care journey.
