Palliative care is a specialized form of care that alleviates pain and other symptoms. The goal of palliative medicine is not to prolong life or hasten death, but rather, to keep the patient as comfortable as possible, while offering support to the patient and their family. Palliative care contributes to the quality of life for patients with life-threatening illnesses at any phase of the disease.
For the patients who are undergoing life-prolonging therapies, palliative care includes symptom management and therapy aimed at restoring function. For the dying patient, it addresses the traditional roles of the hospice movement. During the course of a serious illness, patients and their families should realize that the goals of care can, and do, change, sometimes rapidly. An open line of communication is essential to optimize patient care.
Symptoms Managed through Palliative Care
Some of the common symptoms managed through palliative care include:
- Shortness of breath
- Dry Mouth
- Loss of appetite
- Gastrointestinal problems
- Skin problems
Pain management is one of the most important aspects of palliative care. Because it is now considered a medical specialty, you may wish to consult a physician well versed in pain management if your physician seems unable or unwilling to provide adequate pain control.
Many people with cancer experience pain. Statistics show that 30 to 40 per cent of patients in active cancer therapy, and 70 to 90 percent of patients with advanced cancer report pain. In most cases, pain can be controlled through medications prescribed according to the World Health Organization's Analgesic Ladder, an approach using various levels of medication based on the severity of pain. This type of pain treatment, using drugs, is called pharmacological therapy. Medications may include innon-opioid pain relievers, opioid pain relievers, adjuvant medications (those whose primary purpose is not for pain, but for other conditions), and topical treatments such as a patch, gel, or cream. A study published the Annals of Oncology found a reluctance among cancer patients to take opioid medications due to a belief that such medications are offerred only at the end of life.
Non-pharmacological therapies, those that do not rely primarily on medication to achieve effect, include therapeutic exercise and cognitive behavioral techniques such as deep breathing, muscle relaxation, imagery, meditation, biofeedback therapy, and distraction. Complementary and/or alternative approaches include acupuncture and massage therapy. Integretive medicine refers to the combination of mainstream conventional treatment such as surgery, chemotherapy and radiation with complementary therapies proven to have sound scientific evidence as to their safety and effectiveness.
Shortness of Breath
Shortness of breath, or dyspnea, affects 20 to 80 percent of palliative care patients. Causes of this condition may include, lung disease, fluid in the lungs, infection, anemia, or emotional factors such as anxiety. While medications or oxygen may be used to treat shortness of breath, sometimes measures such as changing position, using relaxation techniques, or improving air circulation may help. More on anemia from chemotherapy treatment.
Cancer-related fatigue may be the result of the general progression of the disease, the effects of medication, or the after effects of treatments such as surgery, chemotherapy, or radiation therapy. The following symptoms are usually associated with fatigue:
- Diminished energy level disproportionate to activity
- Diminished activity associated with physical or intellectual performance
- Diminished motivation; lack of interest in activities
- Exhaustion, apathy, or lethargy
- Generalized tiredness
- Sleep abnormalities
- Irritability, impatience, or changes in mood
The treatment of fatigue is based on first identifying, and then managing, the underlying cause of the fatigue. Once that is accomplished, interventions such as medication, exercise, stress management, and nutrition are used. More on fatigue in mesothelioma patients.
Dry mouth, or xerostoma, is another symptom addressed in palliative care. Causes may be dehydration, depression or anxiety, or may be a side effect of medications such as pain relievers, antidepressants, diuretics, or tranquilizers. Chemotherapy treatments or radiotherapy may also be a cause.
Relief of dry mouth can often be achieved by:
- Drinking plenty of fluids
- Sucking on ice chips or Vitamin C tablets
- Chewing sugarless gum
- Maintaining good oral hygiene
- Providing humidified air
Loss of Appetite
Patients with life-threatening illnesses often lose their appetite, and subsequently, lose weight. If the condition becomes too severe, it is called cachexia. Doctors uniformly agree that nutrition plays a vital role in the patient's well being. Causes of weight loss include inadequate intake of nutrients because the patient can not or does not want to eat, poor absorption of the food that is eaten, and changes in the patient's metabolism.
Weight loss may be managed by:
- Eating smaller, more frequent meals
- Eating high calorie, high protein foods
- Receiving nutritional counseling
There are also medications which may help depending on the patient's desired goal. Some of these medications stimulate appetite, but do not usually increase weight, some stimulate appetite and cause slight weight gain, and still others help prevent nausea and vomiting.
Gastrointestinal problems may be associated with the disease process itself, or as a side effect of treatments or medications the patient is receiving. These may include nausea, vomiting, constipation, and diarrhea.
As mentioned above, there are medications which can help with nausea and vomiting. Your doctor or a nutritionist may also be able to provide eating hints and/or special diets tailored to fit the patient's individual needs. More on diarreah in mesothelioma patients.
There are a variety of skin problems which may accompany cancer, including dryness, itching, rash, sores, and ulcers. It is important to treat these conditions as quickly as possible in order to reduce discomfort and the risk of infection.
- Dryness may be lessened by adding baby or mineral oil to warm bath water, and by applying moisturizers. It is also important to drink 8-10 glasses of water per day.
- Itching and rash may be lessened by adding baking soda to cool bath water, or by applying a cool, moist cloth to itchy areas. Avoid harsh laundry detergents, and change sheets and towels daily.
- Keep skin clean and dry and check skin daily for pressure sores or ulcers which may become infected.
Anxiety is a hallmark of a life-threatening illness. Feelings of fear, worry, or apprehension may lead to long-term generalized anxiety, or short, intense panic attacks. Causes may include difficulty in coming to terms with the illness, fear of isolation and separation, poorly controlled pain, or side effects of medication.
Treatments to control anxiety may include stress management techniques, counseling, support of family and friends, and control of pain or side effects from medication.
Depression, while less common, often affects family members as well as the patient themselves. Depression may be related to loss of the ability to function, changing family roles, limited social and financial support, pain, or other symptoms such as shortness of breath.
Control of the above symptoms is accomplished through antidepressant medication, support and counseling, pain management, and stress management.