Supportive Care/Palliative Care

What is palliative care?

Supportive Oncology care is care for adults and children with serious illness that focuses on relieving suffering and improving quality of life for patients and their families, but is not intended to cure the disease itself. It provides patients of any age or disease stage with relief from symptoms, pain, and stress, and should be provided along with curative treatment.

While palliative care may be delivered by oncology doctors and nurses, they may ask for the help of a specialized team of doctors, nurses, and other specialists who work with them to provide an extra layer of support addressing the patients’ needs and helping patients and their families have a voice in realizing their treatment goals.

Palliative care is also called supportive care. It’s aimed at relieving suffering and improving quality of life. It’s designed to help people live as well as they can for as long as they can, even though they have a serious illness.

Palliative care focuses on helping people get relief from symptoms caused by serious illness – things like nauseapainfatigue, or shortness of breath. Palliative care looks to help with emotional and spiritual problems, too. It’s treatment of the symptoms – it’s not expected to cure any serious illness. The goal is to improve quality of life for both the patient and the family. In the past, the term palliative care was mainly used to describe the act of promoting comfort when aggressive treatment was no longer working – the care given at the end of life. (For more on care when cancer treatment is no longer working, see Hospice Care.)

No matter what it’s called, palliative or supportive care has long been recognized as an important part of cancer treatment. For decades it was simply considered to be part of cancer treatment. But more recently, it’s getting much more attention and study. It has grown into a specialized field of knowledge as well as being a standard part of care given by doctors and cancer care teams.

Palliative or supportive care is given throughout the cancer experience, whenever the person is having symptoms that need to be controlled. This can be from the time of diagnosis until the end of life. It’s appropriate at any age and at any stage in any serious illness.

Palliative or supportive care is also about giving patients options and having them take part in decisions about their care. It’s about assuring that all their care needs are addressed – their physical, emotional, spiritual, and social needs.

Benefits of palliative care

There are many studies that show the benefits of palliative care. Studies have shown that patients who had hospital-based palliative care visits spent less time in intensive care units and were less likely to be re-admitted to the hospital after they went home. Studies have also shown that people with chronic illnesses like cancer who get palliative care have less severe symptoms. They have better quality of life, less pain, less shortness of breath, less depression, and less nausea. Their medical care tends to better align with their values, goals, and preferences. Their families also feel more satisfied.

Palliative care may also increase survival. A 2010 study of lung cancer looked at patients who were given palliative care alongside cancer treatment. The patients who received palliative care along with cancer treatment lived nearly 3 months longer than the patients who received the cancer treatment without the palliative care.

Who should get palliative care and when?

Any person diagnosed with a serious illness who is having symptoms should get palliative care. People with complex medical problems, for instance, someone with heart failure, diabetes, and cancer, should get palliative care.

This supportive care should be available from the time of diagnosis until it’s no longer needed – at any stage and in any care setting.

Who delivers palliative care?

Palliative care is most often begun by the cancer care team, and referrals to or visits with palliative care specialists may happen later.

Your oncologist (cancer doctor), your oncology nurse, and other members of your cancer care team usually treat and help you manage symptoms you’re having. For instance, they may prescribe medicines to help control or prevent nausea and vomiting or to help relieve pain. Oxygen and other measures may be used to help with breathing problems. All of these treatments are palliative care.

Palliative care can also be given by a team of doctors, nurses, and other specialists who work with your oncologist to help treat your symptoms. This option may be considered for people with symptoms that are hard to manage (like severe pain), family distress, or complex medical problems. In this case, your doctor might ask a palliative care team to see you.

This “palliative care team” typically includes a palliative care doctor (who may be board-certified in Hospice and Palliative Medicine), a palliative care nurse, social worker, patient navigator, and maybe a person with a spiritual role such as a pastoral counselor or chaplain. Many hospitals and oncology clinics have these teams as part of the services they provide. They can send the team to patients in intensive care units, emergency rooms, or hospital wards to talk with the patient and family and help with palliative care.

Even though the palliative care team is often based in a hospital or clinic, it’s becoming more common in the outpatient setting. And most of the actual care happens at home. At home, you may take medicines and use other methods prescribed by the team, or you may need help from family members and loved ones. The team provides education and support to the patient as well as to the home caregivers.