Palliative care in the treatment of cancer patients
The role of palliative care is difficult to overestimate. Every year cancer patients are increasing, and are diagnosed globally almost 10 million new cases of cancer. Without looking at the application of the latest methods of diagnosis, approximately half of the patients comes to the doctor already at an advanced stage, so today the oncologists should not only use the most effective methods of cancer treatment, but also to help patients whose days are numbered.
Patients who cannot be treated by all available methods of modern medicine, in need of supportive therapy, maximal relief of symptoms, creating more comfortable living conditions in the latter stages of life. These conditions are included in the term palliative care. The burden of heavy cares and worries to a large extent rests on the patient’s relative that also needs to be well prepared for the upcoming challenges.
Achieving an acceptable level of quality of life is the most important task in cancer patients, and if patients have successfully completed treatment, it means in a greater degree of social rehabilitation and return to work, in the case of incurable pathology the establishment of adequate conditions of existence is, perhaps, the only really achievable goal that is intended to perform palliative medicine.
The last months of the life of a seriously ill person at home, are in a rather difficult situation when the man himself, and his family already know that the outcome is a foregone conclusion. In such a situation it is important to skillfully observe all ethical standards in relation to the doomed, and to show respect for his wishes. You must properly use the available emotional and psychological resources, because time is running short. In this period the patient is in need of various methods of palliative care.
The use of palliative medicine is not limited to Oncology practice. Patients another profile (heart disease, musculoskeletal system, severe neurological damage, etc.), diagnosed with an incurable disease also require relief of symptoms and improvement of quality of life.
The stages of palliative care
Palliative care may need of cancer patients and in the early stages of the disease, then this treatment is complementary to primary therapy, but as the progression of pathology palliative medicine is the leading.
Palliative care to incurable patients can be provided:
- In a hospital with surgical, radiation and chemotherapeutic approaches.
- In the offices of day stay;
- In a hospice.
In the Oncology hospital, the patient, which is not possible to cure the disease, however, can be assisted, designed to alleviate severe symptoms and to improve health.
So, carrying out palliative surgery for a partial removal of the tumor, relieve some symptoms (e.g., intestinal obstruction in colorectal cancer by overlaying the outlet opening on the abdominal wall) can significantly improve the health of patients and increase the level of social adaptation.
Radiation therapy allows to save the patient from significant pain syndrome, and palliative chemotherapy is to reduce the amount of tumor tissue to inhibit cancer progression and reduce intoxication by metabolic products of the tumor. Of course, such treatment may be associated with unwanted side effects, but the success of modern pharmacotherapy, the emergence of new low-radiation methods allow to reduce them to an acceptable level.
Alone or patients with limited mobility we are able to provide palliative care in a day hospital. Visit two or three times a week specialized departments allows to obtain not only necessary medical care and advice of a qualified professional, but also psychological support. For patients who are surrounded by loving and caring relatives, visiting the day hospital can also be helpful to get away from the «home of solitude», and when the patient and his family members are, though all together, but at the same time, one-on-one with the disease.
Most often palliative care is in-home, in the most comfortable for the patient conditions. In this case, of paramount importance is the participation and support of family members who need to be trained the common rules of care for cancer patients, methods of pain relief, especially cooking. It is important that at all stages of palliative care the patient’s condition is observed by professionals who know not only the features of the use of drugs, including narcotic analgesics, but also able to give correct and proper advice to the patient and his family members.
If symptomatic treatment can’t be performed at home, the patient can be placed into hospice care – a specialized medical facility, assisting the terminally cancer patients in the final stage of their lives. Hospice is a free institution in which diverse specialists provides care and treatment of seriously ill patients. Relatives can also get hospice all the necessary guidance and advice. It is important however to remember that no matter how good or help in a hospice, most patients prefer a home environment with family.
Palliative care is not aimed at prolongation of life or cure disease, but it should be possible to alleviate the patient’s condition, to improve the quality of life and provide psychological comfort. As one of the most important symptoms of cancer is the pain is sometimes unbearable and very painful, it is adequate pain relief is one of the most important tasks of palliative care.
The basic principles of palliative care
The most important principles of palliative care can be considered:
The majority of patients in advanced stages of cancer experience pain, often intense and very painful. This pain interferes with his routine, to communicate, to walk, making the patient’s life unbearable, so adequate pain relief is an important phase of palliative care. In the hospital for pain relief can be applied radiation, while patient at home – analgesics for oral administration or in injectable form.
To pain used analgesics, mode, dose and scheme of application of which is determined by the doctor based on the patient’s condition and the severity of pain. So, the drug may be administered hourly intervals of time, wherein the subsequent dose is taken or is to be initiated when the previous one has not yet completed its action. Thus, in a condition where the patient does not have time to experience pain between doses of the drug.
Another scheme to combat pain recommended by the world health organization, is the so-called «analgesic ladder» when as the deterioration of the patient’s condition changes, the painkiller in the direction of strong or narcotic. Usually this scheme to stop the pain begin non-narcotic analgesics (paracetamol, ketorol, for example), turning on the progression of symptoms of the weak (codeine, tramadol), and then to strong opioids (morphine).
Such schemes can be assigned and sick children. Unfortunately, it happens that children suffer from a serious and incurable forms of cancer, and the question of pain relief from them is more difficult than in adults. The child may not always accurately describe the nature and intensity of pain, as an adult it is difficult to assess correctly his words and behavior. In the appointment of morphine the parents may feel concern and even to Express a categorical refusal of its application have a sick child, so the specialist should explain that to stop the pain is extremely important, even if this requires the appointment of morphine.
Violations of the digestive system can be a big problem for cancer patients. They are connected with the General intoxication, lots of medication, chemotherapy and other causes. Nausea and vomiting can be so painful that require the appointment of antiemetic drugs, like symptomatic treatment at all stages of the tumor. In children especially it is important to prevent possible nausea and vomiting as they can cause distrust of the child and his parents to the doctor and to complicate further therapy in connection with conditioned reflex treatments of chemotherapy.
In addition to nausea and vomiting, chemotherapy, and anesthesia opioid analgesics can cause constipation, for correction which is very important to give a laxative to optimize the diet regime and. Children are always assigned to a laxative (lactulose) in the application of morphine to relieve pain.
Nutrition in Oncology plays a very important role. It is aimed not only at improving mood and well being of the patient, but also to correct the deficiency of vitamins and minerals, struggle with progressive weight loss, nausea and vomiting. Approach in nutrition for cancer patients under palliative medicine does not differ from that for patients of all stages of cancer, including treatment which was effective.
The basic principles of nutrition can be considered a balanced composition of protein, fats and carbohydrates, and adequate calorie foods, the high content in the products of vitamins, etc. For a patient in the terminal stage of the disease, the importance can have the appearance and attractiveness of the dishes and the atmosphere during the meal. To provide all conditions for comfortable and enjoyable mealtimes can loved ones who need to be aware of diet, the patient’s family member.
Psychological support is important for any patient faced with the terrible diagnosis of cancer, regardless of stage, however, the terminally ill, who are aware of the nature of the disease and prognosis, the need is particularly acute. If necessary, appointed by sedative drugs and counseling, but the primary role for the still family, which largely depends on how calm will be the last days of life of the patient.
Often family members are asking: should the patient know the truth about his disease? The question, of course, debatable, but awareness and knowledge contribute to universe peace of mind and confidence, overcoming the fear of the imminent outcome. In addition, having a certain amount of time, the patient may try to use it as saturated for at least part of their plans and deciding many issues, including of a legal nature. The majority of patients themselves want to know all the information about your condition so in its sole discretion to dispose meted out, even if it is a small life span.
Cancer treatment is no easy task, involving a wide range of specialists of different profile, and the terminal phase of illness require the assistance of not only medical workers, but ones whose role becomes almost paramount. It is very important to inform both the patient and his relatives about the basic ways of palliative medicine, opportunities to obtain qualified help and advice, especially home care. To alleviate the suffering of the terminally ill is the ethical duty of the physician, and to maintain and create the most comfortable living conditions – task ones.