Palliative Therapy for Cancer Patients

Palliative care is defined as a treatment designed to decrease the symptom burden (e.g. pain) of a serious medical condition and therefore improve quality of life, as well as the offering of guidance to patients and their loved ones to navigate complex medical decision making.

Palliative care is usually given as a team approach and is designed to address both the physical and emotional concerns of people coping with cancer. For instance in cancer, palliative care focuses on relieving the typical symptoms of a cancer patient—like pain, nausea, and anorexia—and allow the oncologist to focus on the tumor treatments themselves. Hospice care is a particular type of palliative care that happens in the last six months of life. Palliative care, in contrast, can be offered at any point in the cancer trajectory: from diagnosis to the terminal phase, or even through cure. . Studies have found that such care greatly improves quality of life, and may even improve survival. That said, palliative care is relatively new on the scene at many cancer centers, and you may need to request a consult yourself.

Palliative Therapy vs. Hospice Care

It's perhaps best to begin defining palliative therapy by what it is not. Palliative therapy is not hospice care. Palliative care does share some common goals with hospice care, but in other ways, they are very different. Palliative treatment may be used even for people with cancer who have early, very curable cancers. Hospice is one type of palliative care that is used in the last months of life. Palliative care is not "giving up," and in fact, one study found that people offered palliative care for advanced lung cancer lived longer than those who did not receive this care.

Goal of Palliative Care

Palliative care is more of a treatment philosophy than any one particular treatment. It aims at reducing pain and suffering by thoroughly addressing all concerns—physical, emotional, and spiritual.

It is true that palliative care is distinguished from curative therapy. Most people will receive conventional treatments such as surgery chemotherapy, and radiation therapy through their oncologist at the same time as they receive palliative care. Palliative care is used at the same time to address the symptoms caused by the cancer and the treatments for the cancer.

Symptoms Palliative Care Can Address

Palliative care can address symptoms such as:

• Pain
• Shortness of breath
• Weakness and fatigue
• Physical limitations
• Nausea and vomiting
• Depression, anxiety, and grief
• Family discord and role changes induced by cancer
• Spiritual issues such as questioning life's meaning and anger at living with cancer
• Caregiver needs
• Practical needs such as finances

In addition to helping with specific symptoms and concerns, a palliative care team can help people coordinate their care and navigate the maze of cancer treatment.

Palliative Treatments

Palliative care refers to care that addresses nearly any symptom a person with cancer may experience, but you may also hear about specific palliative treatments. If your oncologist recommends a treatment such as chemotherapy, it's very important to understand the precise goal of therapy.

It might be confusing to receive "palliative care" from a palliative medicine specialist and then hear your oncologist speak to you about palliative "chemotherapy". Since palliative care is referring to any treatment focused on relieving the symptoms of an illness without necessarily resolving it, chemotherapies that don't have the goal of curing cancer are usually referred to as "palliative chemotherapies."

Palliative Chemotherapy

Chemotherapy can be given in a number of different ways, and it's been found that many people do not understand the distinctions. These include:

• Chemotherapy with a curative intent: With some cancers, such as acute leukemias, chemotherapy may be used with the goal of curing the cancer.
• Neoadjuvant chemotherapy: With a neoadjuvant approach, chemotherapy is given before surgery in order to reduce the size of a tumor so that surgery can be performed. In this sense, it is also a curative approach.
• Adjuvant chemotherapy: Many people are familiar with adjuvant chemotherapy, or the type of chemotherapy given after surgery (for example, with early stage breast cancer). With this approach, the goal is to get rid of any remaining cancer cells that may have traveled beyond the site of the original tumor, in order to reduce the risk of recurrence.
• Palliative chemotherapy: Palliative chemotherapy, unlike other approaches, is not designed to cure a cancer. It may reduce the size of a cancer and improve symptoms (for example, it may shrink a tumor so that it no longer puts pressure on nerves and cause pain), and in some cases, may extend life for a short period of time (often a few months).

While distinguishing these different goals is important, a large study found that the majority of people having chemotherapy for stage 4 cancer (in the study, people had lung cancer or colon cancer) did not understand that there was little chance it would cure the disease. Since chemotherapy can carry significant side effects, people who are considering palliative chemotherapy need to understand the goal of therapy so they can make a personal decision as to the benefits and risks of treatment themselves.

Palliative Radiation Therapy

Palliative radiation therapy is used in a similar way. The goal of treatment is to decrease symptoms even if the radiation is unable to cure cancer. That said, palliative radiation can significantly improve the quality of life for people who are dealing with bone pain from bone metastases, spinal cord compression (when damage to nerve roots occurs due to metastases in the spine) who have respiratory symptoms due to obstruction of an airway, and much more.

Usually on the side of drugs like steroids and oftentimes surgical intervention, palliative radiation may also reduce the risk of neurological damage that could lead to paralysis.

Your Palliative Care Team

Palliative care is by definition given by a team, and the most important member of that team is you. Through careful communication, these people with different specialties work with your input to design a treatment plan meant to make your quality of life as good as possible. Members of your team—in addition to yourself—may include:

• A palliative care healthcare provider or other healthcare specialist
• A nurse
• A social worker
• A chaplain
• A physical therapy or respiratory therapist

This team also works closely with your oncologist and other healthcare providers, so each are aware of the impact of the others treatments and recommendations on your well-being.

When and How Often

Palliative care should ideally begin at the time of a cancer diagnosis and can be started anytime thereafter. Over the past decade many studies have been done with different cancers, with the majority demonstrating advantages to earlier care. While it's quite clear that early incorporation of palliative care can improve quality of life, the question of how often this type of care should take place is now being addressed. A 2018 study published in The Lancet Oncology concluded that rather than a single consultation (or scattered follow-up consultations), integration of palliative care throughout the cancer journey is most beneficial.

How to Get a Palliative Care Consult

Some of the larger cancer centers now offer a palliative care consult at the time someone is diagnosed. Since the whole concept of palliative care is fairly new (though studies have shown its positive impact for some time) you may need to request a consult. If you don't hear about palliative care don't assume that your healthcare provider decided it wouldn't be beneficial for you. As with other aspects of cancer care, being your own advocate can help you get the care you deserve.

A Word From Verywell

For much of history, the goal of cancer treatment has focused on the villain of cancer, and only secondarily on the quality of life for people undergoing these treatments. The advent of palliative care has been a blessing to many, bringing issues relating to quality of life back to the front burner. Since the whole concept of palliative care is relatively new, only recently have guidelines been put into place, and there is a wide spectrum of care at the current time. What this means is that you may need to let your palliative care team know how they can best help you. Raise your most concerning questions and issues, whatever they happen to be.