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Dr Rajagopal Explains All You Need To Know About Palliative Care During Cancer Treatment

1. What is palliative care?

In one sentence, palliative care is the prevention and management of serious illness-related suffering. Think of someone who has been found to have cancer. Let us NOT think of that person as a “cancer patient”; let us try to see him/her as a human being with feelings and emotions; let us try to see him/her as a part of a family and the community. The person’s suffering is not only because of abnormal growth of some cells somewhere in the body. What he/she feels is fear, anxiety, depression, guilt and a myriad of other feelings in addition to pain or other physical symptoms.

2. When is palliative care used in cancer treatment?

Palliative care should start when illness-related suffering starts. That means that it may have to start as soon as the health care system sees the patient first. Even before the doctor has arrived at a diagnosis the pain may have to be treated, and if the person looks exceptionally anxious, there should be a person to gently lay a hand on a hand and say “You look anxious, would you like to tell me about it?” and then to reassure, “We are going to take the best care of you.”

3. Where can one go for such supportive care during one’s cancer treatment?

Once health care providers give attention to the suffering along with treatment of the disease, chemotherapy or radiotherapy-induced symptoms take centre stage in management. When given adequate care and attention, much of the suffering can be removed.

4. How is palliative care different from hospice care?

The terms of palliative care and hospice care are sometimes used synonymously and interchangeably. But more often, the term hospice care is used to signify palliative care at the end of life. While ideally, palliative care should start at the beginning of the illness-related suffering, it assumes greater importance when curative options are no longer available towards the end of one’s life.

5. Is there any research that proves that palliative care is beneficial for cancer patients?

There is indeed a significant body of evidence that demonstrates the benefit of palliative care in cancer treatment. Apart from the rather obvious benefits of improving wellbeing and indirectly influencing the effect of the mind over the body, it has also been clearly proved that palliative care improves longevity when given along with cancer treatment.

6. Are there any side effects of palliative cancer treatment?

The adverse effects of palliative care are minimal and easy to deal with. Many of the usual fears are unfounded. For example, there is a widespread fear that morphine used for the treatment of cancer pain can cause addiction. While theoretically, this is possible, the chances of a person with cancer getting addicted to morphine are infinitely small.

7. How are one’s family and friends involved in this program?

Think of a person getting cancer. Rather obviously, the whole family is affected. The effects on the family members’ lives are notably in the physical, emotional and social domains. When a patient is seriously ill, so much attention is centred on the person that the family members no longer look after their own health. They may discontinue essential treatment for problems like high blood pressure or diabetes and may go into a crisis.

8. Can you give us a model of a palliative care program? Does a patient need to take any precautions before getting enrolled in this care?

Minimum standards for palliative care have been drawn up and are available at Pallium India. The most essential part of a model palliative care program is that the concerned care providers should have had basic training in palliative care. This is particularly relevant in India and other low- and middle-income countries because the average doctor, nurse or other health care provider has not typically had basic training in palliative care as part of their curriculum.

9. What are the various therapies involved in palliative care for a person battling cancer?

Typically, a patient is evaluated for the presence of pain or other symptoms. And their emotional and social backgrounds get assessed. Those who have a serious depressive illness or clinical anxiety state may need appropriate treatment along with cancer treatment. Only a tiny minority of people will need interventional procedures like nerve block for treatment of pain; the mainstay of palliative care management is a treatment with appropriate combinations of medicines including opioids.

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