Topic: Experts call for early palliative care for cancer patients

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What is palliative care?

Palliative care is  specialized medical care focused on quality-of-life issues for patients and their families with serious illness. Palliative care is helpful at any age or stage of illness and is beneficial when started soon after diagnosis.

Types of palliative care

Cancer patients’ needs may change from diagnosis through treatment and after. Oncologists and their staff play an important role in assessing and addressing the support needs of patients and referring patients to experts for palliative services, including:

• Symptoms and side effects of cancer or treatment
• Psychosocial and spiritual needs
• Cultural and ethical concerns and issues
• Family communication issues
• Referrals to specialists and hospice services when needed

Although palliative care may address end-of-life issues for patients with a serious illness, it is important to note that it differs from hospice care.

Why is this topic important?

Palliative care is about helping people with serious illnesses feel better, mentally and physically. While it initially developed from end of life care, research increasingly shows the value of beginning palliative care earlier. By talking with patients about palliative care, doctors can learn about their patients’ preferences and are better able to honor those preferences throughout treatment.

Many patients mistake palliative care for end-of-life care or hospice and may turn down the opportunity to receive palliative care that could help them deal with the side effects of their cancer or treatment.

The American Society of Clinical Oncology weighs in

The American Society of Clinical Oncology (ASCO) is the largest organization for healthcare professionals who specialize in cancer. The theme of ASCO’s 2024 annual meeting was “The Art and Science of Cancer Care: From Comfort to Cure.” This theme refers to the role of palliative or supportive care in cancer care. In her keynote address, ASCO President Dr. Lynn Schuchter focused on providing support to people with cancer and their caregivers in a more holistic way.

Dr. Schuchter said, “By the art of care, I mean the human side of cancer medicine: engaging with patients and their families with deep compassion and understanding, weaving in supportive or palliative care as an integral part of treatment as we try to achieve the best possible outcome for our patients.”

Comfort is key

During her address, Dr. Schuchter noted that comfort requires communication. Doctors and other providers need to be able to talk with patients honestly and respectfully about their diagnosis and prognosis while also ensuring the patient’s comfort. One way that doctors can achieve this is by addressing barriers that may prevent patients from receiving early palliative care.

Misunderstandings about patients receiving palliative care include the following:

• It is often misunderstood and confused with hospice. Patients in treatment may mistakenly believe that palliative care means they need to stop treatments.
• Patients may misunderstand their situation or prognosis. For example, people with advanced cancer that no longer responds to treatment may have a false hope that they will be cured.

Dr. Schuchter explained, “These types of misunderstandings can cause patients to decline palliative care services until quite late. Importantly, these conversations must be had repeatedly over a span of time, so that patients can cope with the information and to best allow for advance care planning.”

Technology can help

As technology advances, Dr. Schuchter sees a role for artificial intelligence (AI). Tasks handled by AI can make more time available for doctors to spend with patients: “Importantly, we hope that AI will help reduce burnout by automating routine electronic health record tasks. Imagine keyboard liberation! More eye contact, more face time with our patients.”

In addition to focusing on supportive care at its annual conference, ASCO has taken action on this topic in two other ways: 1) publishing updated guidelines on palliative care, and 2) training more doctors in oncology and palliative care.

What do the guidelines say?

Dr. Schuchter’s words followed the release of an ASCO guideline update on palliative care. The updated guidelines suggest offering palliative care at the time of a cancer diagnosis or soon after.  This includes cancer patients with unaddressed physical, psychosocial or spiritual distress; caregivers of patients with cancer; and patients with uncontrolled symptoms and quality-of-life concerns. The guidelines also suggest offering palliative care for people with advanced cancers and people who are participating in phase I clinical trials.

Doctors are also encouraged to refer caregivers of people with cancer to palliative care. Palliative care is especially important for people with hard-to-treat symptoms or quality-of-life issues. An effective palliative care meeting touches on the person’s physical, psychological, spiritual, financial and social needs.

This update to ASCO’s 2016 guidance is based on research. A panel of experts reviewed many studies on quality of life, patient satisfaction, symptoms, caregiver burden and survival that show the benefits of palliative care. The experts emphasize that there is no downside to talking about support needs earlier or more often.

The National Comprehensive Care Network (NCCN) also supports the earlier use of palliative care.  The panel recommends that people with cancer be informed about palliative care and screened for needs at their first visit and then repeatedly as clinically indicated.

What does this mean for me?

If you have cancer at any stage or care about someone who has cancer, the growing focus on palliative or supportive care is good news. It is important to be proactive and have a conversation with your care team to address any physical, emotional or social concerns you have related to your diagnosis or care. Your healthcare team should address all your questions and provide you with referrals to services as needed to address your concerns. Your doctors should ask about and address your symptoms, side effects and your emotional and physical wellbeing. It’s important to keep a list of your concerns and present your healthcare team with any unaddressed issues you may face.  

If you have advanced cancer and have not already met with a palliative care specialist, ask to do so now, even if you have just been diagnosed. This specialist can help you with your emotional, practical or physical needs. If you are unsure of your needs, they can help you better understand what’s most important to you and how your needs might affect your treatment choices. Your family members or caregivers might also benefit from talking with a palliative care specialist. If you are participating in a phase I clinical trial, you might also want to ask about palliative care.

Reference:

Schuchter LM, 2024 President’s Address: “The Art and Science of Cancer Care: From Comfort to Cure.” June 1, 2024

Sanders JJ, Temin S, Ghoshel A, et al., Palliative care for patients with cancer: An ASCO guideline update. Journal of Clinical Oncology; 2024; Published online May 15, 2024.

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

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posted 7/17/24