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Palliative care should be integrated into standard treatment

The UK  led the world in developing hospices and effective palliative care.  People like Dame Cicely Saunders were trailblazers in showing how important it is to make sure that, when people can’t be cured and are approaching the end of their lives, it’s important to focus on the things that make what time they have left as comfortable and fulfilling as possible.

So it was heartening to see new US research recently published in the New England Journal of Medicine that supported palliative care and showed it might actually give people a little extra time, as well as improving their quality of life.

As we report on our news feed, the research followed  about 150 people with advanced non-small cell lung cancer. As well as being given ‘standard’ treatment aimed at alleviating their symptoms, half of these patients were also given early, continuous care that involved their doctors, nurses, social workers and chaplains working together regularly to help them deal with the psychological and spiritual aspects of their disease.

The patients given this early treatment not only fared better psychologically, but they lived slightly longer too – a surprising result.

While this slight survival advantage is interesting, the key issue in this study was that the clinicians were seeing palliative care as more than something that should be added in at the last moment of someone’s life. They were seeing it as an integrated part of care.

As a cancer nurse, I’ve seen first-hand how important good palliative care is. I’ve witnessed many examples of where someone’s last months have been made so much more bearable by ensuring that they had good symptom control and psychological support.

Sometimes this is achieved through giving them drugs that directly counteract a particular symptom. But in other cases we use techniques usually associated with trying to cure cancer, which can be really effective in treating symptoms too.

For example, radiotherapy can be invaluable in helping to treat the pain that secondary bone cancer can sometimes cause, while chemotherapy can be useful in shrinking down a tumour that is causing pain even in patients who cannot be cured.  Good palliative care is all about bringing together the expertise of cancer specialists and symptom control specialists, but focusing on quality of life as defined by the patient.

The latest research was accompanied by a thoughtful editorial, which pointed out how this study should help to counter arguments from those who associate palliative care with ‘giving up on life’.  As Amy Kelly and Diane Meier point out, doctors “tend to perceive palliative care as the alternative to life-prolonging or curative care — what we do when there is nothing more that we can do — rather than as a simultaneously delivered adjunct to disease-focused treatment.”

A shift towards seeing palliative care as part and parcel of cancer care, rather than a last resort, is very welcome.

On top of this, the issue has special resonance in the US. Many US health insurers give only ‘piecemeal’ coverage for palliative care. During the debate last year over the health reforms palliative care  was described by some right-wing commentators as ‘euthanasia’ delivered by ‘death panels’.

To a British healthcare professional, who has seen how important good palliative care can be, the idea of it being associated with “death panels” is horrifying.

So it’s important to see this argument countered. Palliative care has nothing to do with intentionally hastening the death of people who are incurable, but it is all about being brave enough sometimes to admit that while a person may not be cured, they deserve a dignified and pain-free death.

Martin

Martin Ledwick runs Cancer Research UK’s information nurse team



Reference

Jennifer S. Temel, et al (2010). Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer N Engl J Med (363), 733-742