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Benefits of integrating palliative care and cancer

Palliative care and end of life care are not one and the same. “End of life care is significant, but it’s only about 10 per cent of what we do,” said Dr. David Dupere, Division Head, Palliative Care, Queen Elizabeth II Health Sciences Centre. “Most of our work is focused on improving the patient’s quality of living.”

Improving quality of living from the palliative care perspective includes: pain and symptom management, communication, decision making, managing treatment complications, care of the dying, psychosocial care, and education. Although research shows not all patients with a life threatening illness like cancer require formal palliative care services, all benefit when health professionals deliver care using palliative care principles.

“Our Palliative Care team does not hold the monopoly on working with patients to improve their quality of living,” said Dr. Dupere. “I applaud the2016_palliativecare many health providers working in the cancer field who use palliative care principles in caring for their patients.”

In treating and managing a patient’s symptoms from the point of diagnosis, the health team is paving the way, making the cancer journey as smooth as possible for the patient. Patients whose symptoms are adequately controlled are better able to continue with their normal daily activities, are able to continue eating well, and tolerate cancer treatments better, all of which contributes to their quality of life and influences cancer survival.

According to patients, five components contribute to quality of living: adequate pain and symptom management; strengthening relationships with loved ones; achieving a sense of control; relieving burden; and avoiding inappropriate prolonging of dying.

Considering the patients’ view and extent of disease, palliative care at the primary care level may end with symptom management, but there are benefits to including other aspects such as broaching the topic of Advance Care Planning and designating a substitute decision maker. Advance Care Planning is a process where an individual considers their values, wishes, and preferences should they reach a point where they are unable to consent to or refuse treatments. It includes talking with family, friends and the person chosen as the substitute decision maker. While initiating the conversation may be difficult, research shows that patients who have these conversations with their health care team and family members are more likely to be satisfied with their care, will probably require fewer aggressive treatments at end-of-life, ease the burden on their family and caregivers, and are more likely to use hospice resources or die at home.

The evidence is clear. Palliative care should not be viewed as alternative to usual medical care, but instead something that can enhance or supplement it.

“While there is a time when patients may need and benefit from formal palliative care services, there is no need for patients to wait for a palliative care consult in preparing for the rest of their lives, said Dr. Dupere, adding, “Health care providers who use palliative care principles in treating cancer patients, are enhancing the patients’ quality of living, and improving the use of health services.”

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