What is palliative care?

Palliative care is care meant to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer. It can be given with or without curative care. Palliative care is an approach to care that addresses the person as a whole, not just their disease. The goal is to prevent or treat, as early as possible, the symptoms and side effects of the disease and its treatment, in addition to any related psychological, social, and spiritual problems.  Patients may receive palliative care in the hospital, an outpatient clinic, a long-term care facility, or at home under the direction of a licensed health care provider. Anyone can receive palliative care regardless of their age or stage of disease.

Many of the same methods that are used to treat cancer, such as medicines and certain treatments, can also be used for palliative therapy to help a patient feel more comfortable. For example, doctors may give chemotherapy or radiation therapy to slow the growth of a tumor that is causing pain. Or surgery may be performed to remove a mass that is pressing on certain nerves and causing pain.

Palliative care is usually provided by palliative care specialists, health care practitioners who have received special training and/or certification in palliative care. They provide holistic care to the patient and family or caregiver focusing on the physical, emotional, social, and spiritual issues cancer patients may face during the cancer experience.

Often, palliative care specialists work as part of a multidisciplinary team that may include doctors, nurses, registered dieticians, pharmacists, occupational therapists, physical therapists, chaplains, psychologists, and social workers. The palliative care team works together with the oncology care team to manage a person's care and maintain the best possible quality of life for them.

Palliative care specialists also provide caregiver support, facilitate communication among members of the health care team, and help with discussions focusing on goals of care for the patient.

The physical and emotional effects of cancer and its treatment may be very different from person to person. Palliative care can address a broad range of issues, integrating an individual’s specific needs into care. A palliative care specialist will take the following issues into account for each patient:

• Physical. Common physical symptoms that can be addressed include pain, fatigue, loss of appetite, nausea, vomiting, shortness of breath, and insomnia.
   
• Emotional and coping. Palliative care specialists can provide resources to help patients and families deal with the emotions that come with a cancer diagnosis and cancer treatment. Depression, anxiety, and fear are only a few of the concerns that can be addressed through palliative care.
   
• Spiritual. With a cancer diagnosis, patients and families often look more deeply for meaning in their lives. Some find the disease brings them closer to their faith or spiritual beliefs, whereas others struggle to understand why cancer happened to them. An expert in palliative care can help people explore their beliefs and values so that they can find a sense of peace or reach a point of acceptance that is appropriate for their situation.
   
• Caregiver needs. Family members and friends are an important part of cancer care. Like the patient, they have changing needs. It’s common for many caregivers to become overwhelmed by the extra responsibilities placed upon them. Many find it hard to care for their loved one who is sick while trying to handle other obligations, such as work, household duties, and taking care of their family. Uncertainty about how to help their loved one with medical situations, inadequate social support, and emotions such as worry and fear can also add to caregiver stress.
  
  These challenges can compromise caregivers’ own health. Palliative care specialists can help families and friends cope and give them the support they need.
   
• Practical needs. Palliative care specialists can also assist with financial and legal worries, insurance questions, and employment concerns. Discussing the goals of care is also an important component of palliative care. Such discussions can also include talking about advance directives and help guiding communication among family members, caregivers, and members of the oncology care team.

The oncologist (or someone on the oncology care team) is the first person one should ask about palliative care. They may refer the patient to a palliative care specialist, depending on their physical and emotional needs. Some national organizations have databases for referrals. For example, the Center to Advance Palliative Care has a list of providers by state. The National Hospice and Palliative Care Organization’s website also has a list of providers.

Whereas palliative care can begin at any point during cancer treatment, hospice care begins when curative treatment is no longer the goal of care and the sole focus is quality of life.

Palliative care can help patients and their loved ones make the transition from treatment meant to cure or control the disease to hospice care by:

• preparing them for physical changes that may occur near the end of life
• helping them cope with the different thoughts and emotional issues that arise
• providing support for family members and caregivers
  
  

Private health insurance usually covers palliative care services. Medicare and Medicaid also pay for some kinds of palliative care. For example, Medicare Part B pays for some medical services that address symptom management. Medicaid coverage of some palliative care services varies by state. If patients do not have health insurance or are unsure about their coverage, they should check with a social worker or their hospital’s financial counselor.

Research shows that palliative care and its many components are beneficial to patient and family health and well-being. In recent years, some studies have shown that integrating palliative care into a patient’s usual cancer care soon after a diagnosis of advanced cancer can improve their quality of life and mood, and may even prolong survival (1, 2). The American Society of Clinical Oncology recommends that all patients with advanced cancer receive palliative care (2).