DEAR DOCTOR K:My mother was recently diagnosed with cancer. I told her to look into palliative care, but she insists that’s for patients who have given up.
DEAR READER:It sounds like your mother may be confusing palliative care with hospice care. It’s a common mistake. Hospice and palliative care are often talked about as if they are the same thing, but they’re not.
Hospice is for people who are expected to live for only a short time and who have stopped treatment to prolong life. Palliative care is medical care that aims to improve a person’s quality of life during any serious illness, fatal or not.
A person can receive palliative care at any stage of his or her illness. In fact, many people could benefit from palliative care starting soon after diagnosis of a serious illness.
Comfort is the main goal of palliative care. As a result, identifying and managing pain is a priority. Painkillers are often necessary. Pain by itself can be extremely debilitating; left untreated, it can suppress the immune system and cause depression.
Palliative care also addresses other types of physical discomfort — for example, shortness of breath, fatigue and insomnia. Constipation can be a major problem. In fact, since it’s a common side effect of certain painkillers, successful treatment of pain may require treatments for constipation. Cancer patients receiving chemotherapy frequently need help with control of nausea and vomiting.
Psychological and social services, for patients and their caregivers, also are included in palliative care. Even if patients remain even-keeled and don’t need psychological support, they may well need advice and clear information. Palliative care specialists can help patients set realistic goals and make treatment choices.
If someone is seriously ill, there are often practical issues he or she may need to contend with: financial pressures, insurance discussions, home support services, coordinating doctors’ appointments, dealing with bureaucratic red tape and arranging transportation.
I recall a patient of mine in her 60s who had cancer. There was little hope she would be alive in five years, and she knew it. She could no longer continue to work. Her financial future was now clouded (she was paying down major personal and family debts). She didn’t understand the insurance policies her late husband had purchased. Finally, she knew it was likely that within a year she was going to need lots of help at home — to buy groceries, to cook, to clean.
She told me: “We all have to die, and the minute I knew the diagnosis I realized I was likely to die a lot younger than I’d hoped. But I was resigned to that, not scared by it. What terrified me was the feeling that my life was going to fall apart in the months or years I had left. Palliative care has prevented my nightmares.”
I hope you can persuade your mother to take a second look at palliative care. It could make a real difference in her quality of life.
Dr. Anthony Komaroff blogs at Ask Dr. K