What Is the Role of Palliative Care in Outpatient Oncology?

May 1, 2023

MaryAnn Fragola, ANP-C, DNP

Palliative care is focused on managing symptoms and providing emotional, psychosocial, and spiritual support to individuals with chronic illnesses, particularly those nearing the end of life. However, it is becoming increasingly recognized that palliative care can also play an important role in the overall treatment of patients with chronic illnesses, such as cancer, at all stages of their disease.

In my practice, I focus on symptom management, particularly in patients with a new cancer diagnosis no matter what the treatment trajectory, whether curative or supportive. This not only allows for the introduction of palliative services but also gives me time to build a rapport with patients and their families. In fact, randomized controlled trials (RCTs) have shown that early palliative care interventions have positively impacted survival in patients with advanced cancer and depressive symptoms.1

Aggressive treatment of early-stage cancers is often associated with serious side effects. These patients deserve the same palliative and supportive care as patients in the later stage of life to improve tolerance of treatment side effects, which will improve overall outcomes. By managing symptoms such as nausea, vomiting, lack of appetite, constipation, diarrhea, fatigue, and insomnia, patients are more likely to comply with treatment regimens and have a better quality of life.

Palliative care should be viewed as a supportive element of care for patients with chronic illnesses at all stages of their disease. Preventing and managing symptoms while optimizing the quality of life throughout the disease process are among the many goals of palliative medicine. If someone expresses a fear of nausea, for example, that creates an opportunity to listen and treat their symptoms for a better outcome. No matter what the symptom, if it is distressing then it is worth addressing.

When I see a patient with a multitude of malignancies, I think about whole patient care beyond the diagnosis. It is important to focus on symptom management as well as emotional, psychosocial, and spiritual support to improve the overall quality of life for patients and their families. Acceptance is part of a wellness plan, emphasizing living better and changing a person’s mindset.

Unfortunately, there often does come a time when comfort becomes the focus of care. As we have established a relationship with our patients, we are comfortable discussing that transition.

Early palliative care improved quality of life and satisfaction with care in caregivers of patients with advanced cancer in one study, highlighting the shared experience of living with advanced cancer among patients and their caregivers.2 These findings add to the body of evidence supporting early palliative care in the setting of a diagnosis of advanced cancer.2 Research findings also suggest that defining palliative care interventions for patients with heart failure may improve quality of life, depression, anxiety, and overall understanding of the disease process and prognosis.3

Education is key to breaking down some of the misconceptions about palliative care. Common misconceptions include:

  • I am not ready for palliative care

  • I am giving up or my doctor has given up on me

  • You can only receive palliative care at the end of life

  • You cannot receive other treatments alongside palliative care programs

  • Palliative care is only for end-stage cancer

  • Palliative care is hospice

Palliative care can be provided at any stage of any illness coinciding with current aggressive treatments such as chemotherapy, surgery, radiation therapy, and dialysis. In other words, palliative care can be provided alongside therapies intended to cure, control, or support the person’s disease and can be provided to patients who still have many years to live, including those who are expected to recover from their illness. Some of the diseases that may benefit from coordination with a palliative care team include chronic obstructive pulmonary disease (COPD), heart failure, Alzheimer dementia, Parkinson disease, chronic rheumatologic disease, and chronic kidney disease. All of these chronic diseases would benefit from having an extra layer of supportive care.

Similar to palliative care, hospice is focused on a person’s overall comfort, including emotional, physical, and spiritual well-being. In fact, hospice is considered a form of palliative care. However, receiving palliative care doesn’t necessarily mean the patient is in hospice.2 Hospice care is simply a form of palliative care that’s given near the end of life when the life expectancy of the patient is 6 months or less.

References

1. Prescott AT, Hull JG, Dionne-Odom JN, et al. The role of a palliative care intervention in moderating the relationship between depression and survival among individuals with advanced cancer. Health Psychol. 2017;36(12):1140-1146. doi:10.1037/hea0000544

2. McDonald J, Swami N, Hannon B, et al. Impact of early palliative care on caregivers of patients with advanced cancer: cluster randomised trial. Ann Oncol. 2017;28(1):163-168. doi:10.1093/annonc/mdw438

3. Chuzi S, Pak ES, Desai AS, Schaefer KG, Warraich HJ. Role of palliative care in the outpatient management of the chronic heart failure patient. Curr Heart Fail Rep. 2019;16(6):220-228. doi:10.1007/s11897-019-00440-3

 

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