From the Grace Archives | Originally published March 28, 2011 | By Dr Ramchandran | 5 Comments
In August of 2010, Jennifer Temel and colleagues published an article in the NEJM that showed that palliative care improves quality of life, symptoms, end of life care, and — lo and behold — overall survival. The survival benefit seen with the early intervention of palliative care for metastatic NSCLC patients was approximately 2 months, the same benefit seen with avastin. The press surrounding this news was immense, with scores of people commenting on it both in the lay press, as well as in the medical literature. As a palliative care physician and an oncologist, however, it made me stop and pause. The reason, I realized, that the Temel paper was making headlines was that survival was improved. Although survival is of tantamount importance, what was striking to me was that the other benefits of palliative care were not as touted- ie improved symptom control, improved quality of life, and improved end of life care.
While I was befuddled about this aspect, others were asking the question, “What is palliative care?” So I must backpedal. Palliative care is a “new-old” medical specialty. It is the newest “official” medical specialty, but its roots are quite simple. Palliative care is “good medicine.” The focus of this specialty is patient-centric care, tailoring medical care to patient goals and values. The approach is multidisciplinary, which is an acknowledgement that no single person can do this alone. Treatment focuses not only on the physical aspects of illness but also on the, social, psychological and spiritual. The goal is not only treatment of the underlying illness, but improved quality of life throughout.
Sounds great so far, right? However, what you should know is that the diversity in palliative care practice is vast. Palliative care is a new medical specialty, and thus the quality of programs is not standardized. Temel’s study used one of the most well renowned and best established palliative care teams in the country. This is not what we see in the rest of the United States. A study published recently on the integration of palliative care into our cancer centers showed an immense array of different programs, many of which do not have a true multidisciplinary team (a key facet of palliative care) or trained specialists. The bottom line is that you would not have a cardiologist administer chemotherapy, however at this time there is no guarantee that a palliative care physician has specific training in palliative care.
If there is a well established palliative care team at your cancer center, then I would recommend that you take advantage of this resource, and the earlier the better. There is clear evidence from multiple studies that palliative care improves overall symptom control, toxicity management, and psycho-social support. With a strong palliative care team, it is clear that they can help you live longer and better.
So I ask the question, is palliative care right for you? If you have cancer, and you have access to a strong palliative care team, the answer in my mind, is “yes”, and that it isn’t reserved for people who have exhausted their anti-cancer treatments.
(Of note, in some institutions the palliative care team goes by the term supportive care.)