Palliative Care For Cancer – What It Involves

Key Takeaways Palliative care is extra support for people with a serious illness such as cancer. Its aim is to ease symptoms and stress and to improve quality of life. It is not the same as hospice care and it does not mean treatment has stopped. It can run alongside chemotherapy, radiation or surgery from the day of diagnosis. A palliative care team looks after pain, breathlessness, nausea, tiredness, poor appetite, low mood and worry, and also supports the family. Palliative chemotherapy is chemotherapy given to control the cancer and ease symptoms when a cure is unlikely. It is a different thing from palliative care itself. Palliative care can be given in a hospital, in a clinic or at home. Asking for palliative care early is common and sensible. It does not mean you are giving up.

When someone you love is told they have cancer, the word “palliative” can make a family go quiet. Many people hear it and think the doctors have run out of options. That is not what the word means. Palliative care is about how you feel and how well you can live each day, and it can begin at any stage of cancer.

This guide explains the palliative care meaning in plain language, what palliative care in cancer usually includes, how it differs from hospice care and what palliative chemotherapy is.

What Is Palliative Care?

Palliative care is specialist support that focuses on relieving the symptoms and stress of a serious illness. The World Health Organization describes it as an approach that improves the quality of life of patients and families by preventing and relieving suffering. This is done through early identification, careful assessment and treatment of pain and other physical, emotional and spiritual problems (WHO, 2020).

The Palliative Care Meaning

The word comes from the Latin pallium, which means a cloak. The idea is to cover and protect the person from the worst of the symptoms, even when the illness itself cannot be removed. Palliative care is not limited to cancer, but cancer is one of the most common reasons people need it.

The WHO estimates that only about 14 per cent of the people who need palliative care worldwide actually receive it (WHO, 2020). Many families in India simply do not know to ask for it.

Palliative Care in Cancer

Palliative care in cancer is delivered by a team. Depending on your needs, the team may include a palliative care doctor, oncology nurses, a pain specialist, a dietitian, a physiotherapist, a counsellor or psychologist and a social worker. The care is built around what is troubling you most.

Area of Support	How the Care Team Helps
Pain relief	Cancer pain is common but it can usually be controlled with the right medicines, nerve blocks or other methods. You do not have to put up with it.
Breathlessness, cough and swallowing trouble	The team looks for the cause and treats it and teaches simple breathing and positioning techniques.
Nausea, vomiting, constipation and poor appetite	These are treated as seriously as the cancer itself, with advice on the diet for cancer patients.
Tiredness and weakness	The team checks for fixable causes such as anaemia, poor sleep or low mood.
Emotional and spiritual support	Fear, sadness and sleeplessness are common. Counselling and listening time are part of care, not an extra.
Family support	Carers get guidance on how to help and on how to look after themselves.
Help with decisions	The team helps you understand choices, talk about goals and plan ahead so that treatment matches what matters to you.

When Should Palliative Care Start?

Many people believe palliative care is only for the last weeks of life. This is a common misunderstanding. Current guidance from the American Society of Clinical Oncology recommends that people with advanced cancer be referred to a palliative care team early, alongside their cancer treatment, ideally within eight weeks of diagnosis (Ferrell et al., 2017).

There is evidence behind this advice. In a trial of people with advanced lung cancer, those who received palliative care together with standard cancer care from the start reported a better quality of life and less low mood than those who received standard care alone (Temel et al., 2010). The study looked at one cancer type, but it changed how many cancer teams think about early supportive care.

You might consider asking for palliative care if symptoms are hard to control, if treatment side effects are wearing you down, if you or your family feel overwhelmed, or if the cancer has spread or come back.

Doctor’s Insight “Families often wait until things are very difficult before asking for palliative care. I would encourage people to ask earlier. Controlling pain, nausea and anxiety makes it easier to get through treatment, and it gives the family a clearer picture of what to expect.” Dr. Tarang Krishna – Cancer Healer & Managing Director, Cancer Healer Center

What Is Palliative Chemotherapy?

Palliative chemotherapy is chemotherapy given when the goal is not to cure the cancer. The aim is to shrink or slow the tumour, ease symptoms such as pain or blockage and, in some cases, help people live longer with a better quality of life. The same idea applies to radiation therapy, wherein palliative radiation can ease bone pain or relieve pressure from a growing tumour.

Palliative chemotherapy and palliative care are two different things. Palliative chemotherapy is a cancer treatment decided by your oncologist. Palliative care is a layer of support that can go alongside it. A person can receive both at the same time.

The decision to start, continue or stop palliative chemotherapy should always be shared. Your oncologist should explain the likely benefit, the side effects and what happens if you choose not to have it. Ask these questions openly. A person’s wishes and tolerance matter as much as the scan results.

Palliative Care vs Hospice Care

These two terms are often mixed up. Both focus on comfort, but they apply at different times.

Palliative care	Hospice care
When it can start	At any stage, from diagnosis	Usually when the focus is entirely on comfort near the end of life
Alongside cancer treatment	Yes, it can go with chemotherapy, radiation or surgery	Usually no, treatment aimed at the cancer is stopped
Main aim	Relieve symptoms and support the family during treatment	Comfort, dignity and support in the final phase of life
Where it is given	Hospital, clinic or home	Hospice centre, hospital or home

In short, hospice care is one form of palliative care that comes late in the illness. Palliative care as a whole is much broader.

Palliative Care for Cancer Patients at Home

Many families prefer palliative care at home because the person is in familiar surroundings. Home-based care usually involves visits from a nurse or doctor, help with medicines and pain control, wound or stoma care, feeding support and training for family carers. It works best when it is planned with the treating oncologist and the palliative care team so that everyone follows the same plan.

Before going home, ask the team these questions:

• Whom do we call at night or on a weekend if the pain gets worse?
• Which medicines are for which symptom, and how do we give them?
• What warning signs mean we should come to the hospital?
• Who will help us with equipment such as a hospital bed, oxygen or a feeding tube?

Home care is not suitable in every situation. Severe uncontrolled symptoms or the need for round-the-clock monitoring may mean that a hospital stay is safer.

When Should You Speak to a Doctor About Palliative Care?

Speak to your doctor if pain is not controlled, if you are breathless, vomiting or unable to eat, if you are exhausted most of the day or if you feel low, anxious or unable to sleep. Also ask if the cancer has spread or come back, or if a family member is struggling to cope.

Go to an emergency department straight away for sudden severe pain, difficulty breathing, heavy bleeding, confusion, fainting or a fever during chemotherapy.

References

Ferrell, B.R., Temel, J.S., Temin, S., et al. (2017) ‘Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update’, Journal of Clinical Oncology, 35(1), pp. 96-112. doi:10.1200/JCO.2016.70.1474.

Temel, J.S., Greer, J.A., Muzikansky, A., et al. (2010) ‘Early palliative care for patients with metastatic non-small-cell lung cancer’, New England Journal of Medicine, 363(8), pp. 733-742. doi:10.1056/NEJMoa1000678.

World Health Organization (2020) Palliative care.