World Cancer Day: Understanding The Role Of Palliative Care During Cancer Treatment

Palliative care is a relatively new specialty of Medicine. The name is derived from the term palliate, which suggests, to make less severe. In medicine, the term palliate means to reduce the severity of pain or disease without curing or eliminating the underlying cause, and palliative care in general focuses on improving the overall quality of life for people facing serious or life-threatening illness, not on curing the cause of the illness.

Palliative care, a health care specialty that's both a philosophy of care and an organised, highly structured system for delivering care to persons with life-threatening or weakening illness from diagnosis till death then into care for the loss and trauma in the family. The World Health Organization (WHO) defines palliative care as "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." The goal of palliative care is, therefore, to enhance the standard of lifetime of both patients and families by responding to pain and other distressing physical symptoms, also provide medical care and psycho-social and spiritual support. This is why it's best administered by multi-dimensional, interdisciplinary team, comprising of Palliative Care and Pain Physicians, Counselors, Social Workers, Nurses, and Volunteers.

Cancer and several other Non-Communicable Diseases have emerged as major public health issues in India. It is estimated that one million new cases of cancer occur each year in India, with over 80% presenting at stage III and IV. Cancer control needs a multidisciplinary approach and palliative care is a crucial component of this approach. It is estimated that in India the total number of individuals, who need palliative care is probably 6 million a year.

Palliative care is an important and essential part of cancer care therapy and offers three categories of support:

1. Pain management is vital for comfort and to reduce patients' distress. It is estimated that less than 3% of India's cancer patients have access to adequate pain relief facilities. Every hour, in India more than 60 patients die from cancer and in pain. Palliative care and Pain Physicians, nurses, counselors and families can collaborate to identify the sources of pain and relieve them with pharmacotherapy and other forms of advanced treatments like specific nerve block, radiofrequency ablation, phenol neurolysis in which nerves are numbed with heat or chemical with utmost care to maintain their function and at the same time reduce pain.

2. Symptom management involves treating symptoms other than pain such as nausea, weakness, bowel and bladder problems, mental confusion, fatigue, and difficulty in breathing with medications, nursing interventions, physical therapy and psychosocial support.

3. Emotional and spiritual support is important for both the patient and family in dealing with the emotional demands of critical illness and need for long term care.

Palliative Care helps families understand the alternatives available for care, improves lifestyle of patient; reducing the concern of loved ones and allows for valuable support system. Researchers have studied the positive effects palliative care has on patients with cancer. According to recent studies, patients who receive palliative care, report improvement in pain and other distressing symptoms, like shortness of breath, nausea, communication with their family members and doctors, and emotional and psychological status.

(Dr. Navita Purohit Vyas is a Consultant, Pain and Palliative Care at Kokilaben Dhirubhai Ambani Hospital, Mumbai)

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