Welcome back. What is palliative cancer care? The term palliative comes from the Latin word palliare which means to cloak. Palliative care in modern day forms refers to medical treatments whose purpose is to reduce patient's suffering and improve their quality of life. Palliative care does not address the treatment of the disease process itself. The World Health Organization highlights the difference between patient-centered care and disease-centered medical treatments with respect to a number of dimensions. Palliative care focuses on both patients and their family members, vis-a-vis quality-of-life-related issues. It emphasizes both prevention and relief of suffering by trying to identify patients concerns as early as possible. It places an emphasis on holistic aspects of care whether physical, psychosocial, or spiritual. In the words of the WHO and I quote, "Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual." While the concept of palliative care is applicable to a number of clinical settings, for example the treatment of patients with advanced kidney, neurologic, and cardiac disease. In the oncology setting, it has become an integral part of care being implemented from the initial diagnosis of cancer and throughout all the stations of the disease. In contrast to other disease settings, palliative cancer care is not limited to patients with advanced cancer and end of life care, but to all patients regardless of their stage of the disease. In addition to reducing suffering and increasing quality of life and function, the introduction of palliative care to the chemotherapy regimen has been shown to potentially improve overall survival rates as well. Which of the following treatments would you expect to be considered as part of palliative cancer treatment? Does palliative cancer care address only chemotherapy related toxicities or does it also addressed symptoms which are related to the cancer itself? The answer to these questions is that palliative cancer care addresses patient symptoms and quality of life regardless of the cause, whether the result of the drugs used in treating the cancer such as chemotherapy induced nausea and vomiting, symptoms resulting from invasion of the tumor into the surrounding tissues and organs, often requiring analgesia for pain relief, concerns related to the difficulties faced by patients and their caregivers in coping with the emotional and spiritual challenges of the disease, and a general reduction in the ability to function each day. How is palliative cancer care different from supportive cancer care? In practice, one can distinguish between two concepts which are taking places simultaneously with the broad context of palliative care. The first is called supportive care and it relates more to improving quality of life among patients usually those with localized cancer and for whom the main concern is the side effects of the treatments. The second termed palliative care is usually used when referring to patients with advanced metastatic cancer. For these patients, quality-of-life-related concerns are significantly affected by the advancing disease in addition to the side effects of chemotherapy and other cancer treatments. These two concepts, supportive care and palliative care, represent two aspects along the same continuum. It's still a new, still different from the traditional, the conventional way of dealing with people. So, this approach is aiming to lessen and alleviate the people suffering, patient's suffering and his family while they are facing incurable disease. So, it's when we talk about suffering, it means the aspects of a human being that comes from a physical suffering, psychosocial suffering and spiritual suffering. So, we say that a palliative approach is the kind of medical practice that have this intention to lessen and at the same time not to prolong people's life, just to give them a quality of life. Supportive cancer care is associated with localized cancer, while palliative cancer care is associated with advanced cancer. Supportive care is in patients receiving adjuvant treatment to prevent cancer recurrence, while palliative care is in patients undergoing palliative chemo radiotherapy to improve quality of life or slow cancer progression. Supportive care addresses the side effects of chemotherapy and other anticancer therapies. Palliative care addresses both treatment and cancer-related symptoms. Supportive provided to patients with a better prognosis usually during survivorship, while palliative care is provided to patients for whom the oncology treatment may extend survival, but will eventually require end of life care. The palliative care is actually all the time changing, the definitions are changing all the time. Historically, it was treatment of end of life care and it's still the main issues that it's dealing with. But the subjects that are actually quality of life are now widespread to other area and the modern concept is that every patient who was diagnosed with cancer needs supportive care, what we called that it's actually widens the borders of the palliative care and also it will not been to so extent as end of life care, still you will have symptomatic problems during all the treatments period, probably later and even the care of the survivors that it's completely different from palliative care. It's still dealing with the same problems like palliative care but in a different level. How is supportive or palliative care integrated in the conventional oncology setting? Today, oncology treatment guidelines require the provision of supportive and palliative care as an integral part of patient care. In order to meet this goal, there is a need for trained supportive palliative care practitioners, who are oncology health care professionals with an approach to patient care, which may differ in a number of ways from that of their colleagues. Supportive palliative care emphasizes a patient-centered approach, while conventional care usually emphasizes a disease-centered approach. Supportive palliative care addresses quality of life, coping, patient empowerment, while conventional care often addresses survival, anti-cancer effects of treatment. Supportive and palliative care evaluate subjective patient reported outcomes and qualitative data, while conventional care often is guided by objective disease-related parameters such as tumor markers, PET CT, and so on. Supportive palliative care is more with bio-psycho-social-spiritual model of care, while conventional care is more biophysical-oriented strategy. Supportive palliative care is patient tailored multidisciplinary treatment, while conventional care uses protocol-based treatments. Personalized medicine considers cancer type and cell receptor features. In supportive palliative care, patient's caregivers are considered as important partner when addressing concerns, while in conventional care the focus is solely on the patient.
