For patients with a severe or late-stage cancer diagnosis, palliative care allows them to focus on end-of-life planning and non-medical goals.
Dr. Maria Dans serves as Chair of the National Comprehensive Cancer Network Guidelines Review Panel in Palliative Care.
When someone receives a diagnosis of severe or late-stage cancer, their focus is typically on medical treatment options such as surgery or chemotherapy.
Palliative care allows patients to also consider their non-medical goals. “The basic idea behind palliative care is that it’s an extra level of support for patients,” she said. “The emphasis is on symptom management and optimizing the person’s and the family’s quality of life.”
Palliative care includes preparing advanced care planning documentation. “There are things that are called living wills or ethical wills,” Dr. Dans said, “where it’s less about you thinking about how you’re going to give your property away if you die and more about what’s important to you, what you want to leave as a legacy.”
“Having those sorts of non-medical goals in mind is important, particularly when facing a life-limiting illness,” Dr. Dans said.
“I work in the hospital and it’s difficult for people when they get sick, particularly if they get debilitated and they find themselves being in and out of the hospital. Health care professionals — doctors in particular — tend to focus on the next procedure, the next medication, and that may not be the most important thing for a person.”
When to consider palliative care
Dr. Dans encourages patients to consider palliative care from the beginning of their diagnosis. “All of the major oncologic societies at this point recommend early palliative care, particularly for advanced age,” she said.
Dr. Dans said that doctors may not lead with a referral to palliative care, but that patients should ask about it when they receive their diagnosis.
Much of palliative care can now be offered digitally, which Dr. Dans said has greatly improved the reach and quality of palliative care. “The pandemic probably accelerated virtual medicine by at least a decade,” she said.
“There was a real niche that was unfilled for doing advanced care planning from in the comfort of your own sofa with your dog and your family sitting beside you.”
Telemedicine has also made it much easier for patients with restricted mobility. “Prior to the pandemic, our visits were always in person, but our no-show rate was really high — 50% to 75%,” Dr. Dans said. “With virtual visits, our no show right now is less than 10%.”
Planning for the end
Palliative care differs from hospice care, which is offered to patients who’ve been given a less than six-month life expectancy.
“When somebody gets to the point where the disease directed therapy, whatever that is, just seems more burdensome than beneficial, that’s probably the time to start thinking about hospice,” Dr. Dans said. “Also, if somebody gets to the point where going to the hospital doesn’t make them feel better anymore, those are sort of times when I think hospice might be appropriate.”
By focusing on end-of-life planning, palliative care can also help patients come to terms with a difficult diagnosis.
“Acknowledging that the diagnosis is bad and that there may not be great options is hard,” Dr. Dans said, “but not acknowledging it means it sort of sits there like a 100-ton elephant floating in the middle of the room. It’s not infrequently that I see people feel relieved, which is a weird thing to feel when you acknowledge the fact that this is a terrible diagnosis and you’re going to die, but it’s better than uncertainty.”
