Cancer is one of the most common diseases that require palliative care. According to WHO, 34% of adults who need palliative care suffer from cancer. In the past, palliative treatment was mainly administered to cancer patients in the advanced stage. With the development of palliative medicine, palliation has expanded its coverage to other conditions, as well as cancer patients of all stages.
In fact, research has shown that it is beneficial to get palliative care early on, at the time of diagnosis or when the symptoms start to show. Palliative treatment, 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.
In this article, we will cover the role of palliative care in helping patients with cancer throughout their cancer treatment journey, for a variety of contexts, from patients who are in the initial diagnosis days to advanced cancer cases.
1. Cancer-Related Symptoms and Problems Addressed with Palliative Care
As a general rule, palliative care focuses on addressing the patient’s symptoms and suffering using a variety of treatments. It is a treatment philosophy rather than one specific therapy. Palliation is a highly collaborative process, whereby the palliative care team discusses and recommends treatment based on care goals and values of the patient, as well as their family.
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 usually follows the tumor or the nerves that are being compressed. Additionally, in the wake of a cancer diagnosis, patients and families may feel overwhelmed and unprepared for an uncertain future. Besides helping with chronic symptoms, your palliative care team will also guide you through the complex process of cancer treatment and offer psychological support.
Palliative care can address the following problems for cancer patients and families:
- 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.)
2. Palliative Treatments for Cancer
Cancer palliative care may use the same techniques that would treat a tumor 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.
2. 1. 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 tumor 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 tumors. 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 tumor and improving clinical symptoms. For instance, if the tumor is pressing on a nerve causing the patient severe pain, palliative chemotherapy may help.
2.2. 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.
2. 3. 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.
2. 4. 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.
2. 5. 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.
3. 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
- Respiratory therapist
- Social worker
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.
4. How Soon and How Often to Receive Palliative Care
As noted above, in many cases, palliative care shows improved results when it is started early. Therefore, cancer patients and families are recommended to discuss with their oncologist and palliative specialist early on to at least understand how palliation can benefit you and what palliative options are available. The conversation can start as early as when cancer is diagnosed. While this may sound too early for some people, it is better to begin at this early stage to pre-empt and address future problems.
Frequency of receiving palliative care treatments depends on a variety of factors, intensity of symptoms or expected symptoms, patient’s responses to therapy, as well as other considerations such as patient’s wishes and funding available. Again, patients are encouraged to discuss the options with the palliative team. 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.
5. Cancer Care at Home with Ninkatec Palliative Care Team
We hope that this article manages to shed some light on the importance of palliative care in improving the quality of life of cancer patients and their family. In addition to standard cancer treatment, palliative care is indispensable for cancer patients to remove obstacles that negatively impact their daily activities, relieve symptoms of cancer and side effects of cancer treatments, thereby elevating patient’s well-being during recuperation. It is for all stages of cancer treatment and all types of cancer. The time to start palliative care discussion is best to be as soon as diagnosis is made, for the palliative care plan to be best customised and developed according to the patient’s care goals and cancer treatment progress.
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 here. 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.