Palliative Care for Cancer Patients

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Oncology guide

- What is Palliative Care ?

Palliative care is a form of comprehensive, integrated healthcare that is offered to patients and their caregivers through a multidisciplinary team, including doctors, nurses, pharmacists, social workers, psychological support specialists, religious figures, and other specially trained professionals. Its aim is to alleviate or reduce the suffering of patients facing serious illness. Palliative care focuses on managing pain and other symptoms for patients with serious diseases, such as cancer, and can also help patients cope with the side effects of medical treatments used for cancer patients. The goal is to provide comfort and improve the quality of life for patients and their families. This type of care is provided alongside other treatments the patient may receive.

Palliative care starts on the first day of cancer treatment, not when the disease treatment fails, and it does not indicate that the patient's condition is hopeless. The care is delivered by a team working in collaboration with the oncologist, focusing on treating all symptoms, including pain, as well as other symptoms like nausea, shortness of breath, general weakness, etc. Early access to palliative care can lead to improved quality of life for patients with serious diseases, reduce depression and anxiety, increase patient and family satisfaction with care, and, in some cases, prolong life.

 What Types of Diseases Benefit from Palliative Care?

 Palliative care can be provided to those with serious or life-threatening illnesses from all age groups. It can benefit adults with diseases such as:

• Cancer.
• Blood disorders and bone marrow diseases requiring stem cell transplantation.
• Heart disease.
• Cystic fibrosis.
• Dementia.
• End-stage liver disease.
• Kidney failure.
• Lung diseases.
• Parkinson’s disease.
• Stroke, and other serious conditions.

- Goals of Palliative Care

1. Improve the quality of life for cancer patients by focusing on pain management and symptoms associated with the disease.
2. Provide psychological, social, and spiritual support to patients and their families during treatment and after death, if necessary.
3. Allow the patient the opportunity to make decisions, ensuring dignity in their life.
4. Alleviate both physical and psychological suffering of the patient.
5. Empower the patient to remain as independent as possible.

- Signs and Symptoms that Palliative Care Helps Improve

• Pain.
• Nausea or vomiting.
• Anxiety or irritability.
• Depression or sadness.
• Constipation.
• Difficulty breathing.
• Loss of appetite.
• Fatigue.
• Difficulty sleeping.

- Basics of Palliative Care

1. Respect for the patient.
2. Patient safety.
3. Maintaining patient privacy.
4. Empathy for the patient.

- Components of Palliative Care

1. Treating pain and the effects of the disease or treatment (e.g., fatigue, nausea, loss of appetite, anxiety, depression).
2. Caring for the psychological, social, and spiritual needs of the patient and their family based on their specific beliefs.
3. Supporting the family as a unit and providing ongoing practical support by guiding and training them on roles, tasks, and skills to ensure basic care for the patient, helping create an optimal therapeutic environment for the patient to reduce suffering and improve quality of life.
4. Caring for patients in advanced stages of the disease and providing the best possible care without attempting to hasten or delay death.

- Types of Services Provided Through Palliative Care

• Medical Consultation: The palliative care team provides medical consultation to control the signs and symptoms the patient is experiencing during treatment, while remaining under the care of the treating medical team receiving chemotherapy, surgery, radiation, or other treatments.
• Inpatient Palliative Unit: This unit provides comfort to the patient and their family through ongoing care from palliative care specialists, aiming to improve quality of life and offer more flexible visit schedules, allowing the patient to spend more time with family and loved ones.
• Home Care Program: The home care team offers its services throughout the week, coordinating regular visits to the patient’s home to provide treatments, advice, and emotional support, under the supervision of the palliative care team in the hospital.

- The Role of the Medical Staff in the Palliative Care Team

The treatment team, consisting of multidisciplinary experts, offers support and care in their specialized fields: doctors, nurses, social workers, occupational therapists, dietitians, physical therapists, and communication specialists. The goal of the team is to provide comprehensive support and accompany the patient in meeting their physical, psychological, and spiritual needs while maintaining the patient’s dignity and helping them continue managing their life and improving their quality of life.

- What is the Role of the Palliative Care Nurse ?

1. Nurses in palliative care play a variety of roles to ensure the continuity of patient care, including monitoring symptoms, evaluating the patient’s health, and ensuring appropriate daily care.
2. Facilitating adherence to drug protocols while maintaining communication with patients, doctors, and other healthcare providers.
3. Many patients need assistance with mobility, and palliative care nurses help maintain physical movement, perform daily activities, and assist with personal hygiene and nutrition.
4. Creating a safe and comfortable environment for patients and their families, promoting a sense of security.

- Required Skills for Nursing in Palliative Care

Nurses in palliative care must possess a blend of skills to meet the physical, emotional, and psychological needs of patients facing serious diseases. Key skills include:

• Excellent communication to convey sensitive information and foster understanding with patients and their families.
• Ability to assess the severity of symptoms and pain levels accurately, and proficiency in pain management and symptom control.
• Collaborative skills for seamless teamwork with other healthcare professionals.

- Advice for Patients Preparing for the First Consultation

• Prepare a list of symptoms, noting what relieves or worsens them and whether they affect daily activities.
• Prepare a list of medications and supplements being taken, including dosage and frequency.
• Bring a family member or friend to the consultation.

- Work Activities During the Consultation

During the consultation, the palliative care team discusses the symptoms the patient is experiencing, current treatments, and how the disease is impacting the patient and their family. A care plan is developed with the patient to alleviate suffering and improve their daily life.

The palliative care plan is designed based on the patient’s life and needs, and can include elements like:

• Symptom control to improve comfort and health.
• Support and guidance for difficult decisions resulting from serious illness.
• Care techniques such as deep breathing, therapeutic touch, meditation, or listening to music.
• Referrals to specialists like psychologists or pain management experts.
• Advance care planning to discuss goals and wishes for future care.

- References

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·  Daaleman, T.P., et al. "An Exploratory Study of Advance Care Planning in Seriously Ill African American Elders." Journal of the National Medical Association, vol. 100, no. 12, 2008, pp. 1457–1462.

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·  Dumenci, L., et al. "On the Validity of the Rapid Estimate of Adult Literacy in Medicine (REALM) Scale as a Measure of Health Literacy." Communication Methods and Measures, vol. 7, no. 2, 2013, pp. 134–143.

·  Dzeng, E., et al. "Influence of Institutional Culture and Policies on Do-Not-Resuscitate Decision Making at the End of Life." JAMA Internal Medicine, vol. 175, no. 5, 2015, pp. 812–819.

·  El-Jawahri, A., et al. "Use of Video to Facilitate End-of-Life Discussions with Patients with Cancer: A Randomized Controlled Trial." Journal of Clinical Oncology, vol. 28, no. 2, 2010, pp. 305–310.

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·  Fried, T.R., et al. "Health Outcome Prioritization as a Tool for Decision Making Among Older Persons with Multiple Chronic Conditions." Archives of Internal Medicine, vol. 171, no. 20, 2011, pp. 1854–1856.

·  Mayo Clinic. "Palliative Care." Mayo Clinic, www.mayoclinic.org/ar/tests-procedures/palliative-care/about/pac-20384637. Accessed 6 Jan. 2025.