Palliative care: Treatment for the patient as a whole person

Dr. Goto.

Palliative care is specialized medical care for people living with a serious illness such as cancer. It is a specialty that focuses on quality of life for patients and their families through the relief of physical, psychological, social/practical and spiritual/existential suffering. One of the founders of palliative care, Dame Cicely Saunders, coined the term “total pain” to describe all-encompassing patient suffering caused by these four disparate factors.1 Let us explore each of these areas in more depth.

Physical symptoms

Palliative care can help with symptoms that arise from the disease itself, or as side effects of treatment. Pain is one of the most frequent reasons cancer patients are referred to palliative care.

We work to relieve pain through medications and, if appropriate, can assist in coordination with other specialists such as radiation oncologists, interventional pain specialists and physical therapists. Other physical symptoms that are commonly addressed in the palliative care setting are nausea/vomiting, constipation, loss of appetite, fatigue, shortness of breath and insomnia.

Psychological symptoms

There are many emotions that can come with the stress of experiencing a serious illness such as cancer. Depression, anxiety and fear of suffering are some of the symptoms that can be addressed in palliative care. Palliative care can help through medications for the patient, counseling for the patient and/or the family, and referral to support groups and advocacy organizations, among other modalities.

Social symptoms

Cancer can significantly impact patients’ physical and emotional health, but can also have far-reaching practical consequences as well. A patient’s inability to work, difficulty maintaining valued roles within the family and the community, financial stresses and fatigue on the part of family/caregivers can all contribute to social suffering. The interdisciplinary palliative care team can help with access to resources as well as work with patients to maintain sense of self, identity and belonging despite perhaps evolving abilities and roles be they temporary or permanent.

Spiritual symptoms

The experience of cancer can bring up a variety of existential concerns for patients, such as the search for meaning and purpose in life, fear of the unknown, a strengthening or weakening of previously held faith or evolution of spiritual beliefs. Patients can define spirituality in any number of ways, religious or not. Regardless of the patient’s religion or belief system, the interdisciplinary palliative care team can help address this often-overlooked aspect of the experience of illness.

Palliative care covers a broad range of patient concerns and sources of suffering in an attempt to treat the patient as a whole person. This is accomplished by an interdisciplinary team that can involve doctors, nurses, social workers and chaplains. Swedish palliative care is available to all Swedish Cancer Institute cancer patients regardless of type of cancer, stage of illness or prognosis; patients can receive palliative care alongside any and all cancer-targeted treatments such as chemotherapy and/or radiation.

We work with all patients, from people with curable cancers dealing with illness and treatment-related physical symptoms, to people who are grappling with practical and existential questions as they continue treatments for a life-limiting cancer, to people who have decided to forgo cancer-targeted treatment and focus solely on quality of life. If you or someone you love could possibly benefit from palliative care, please ask your oncologist to make a referral to any of our clinics.

1 Embracing Cicely Saunders’ concept of total pain. BMJ 2005;331:576

This article is from the Spring/Summer 2017 issue of Life to the Fullest, the newsletter from the Swedish Cancer Institute (SCI) dedicated to those with cancer, cancer survivors, and their family members and caregivers.