Palliative Chemotherapy And Other Palliative Medical Care

Palliative chemotherapy is used to prolong life and improve cancer symptoms. This type of treatment is different than how people usually think of chemotherapy. Most people think of it as a treatment to cure cancer.

What is palliative care?

It is hard to live with an illness that cannot be cured. You may feel that your treatment is doing more harm than good. You may have pain or other disturbing symptoms. Palliative care is for people who have illnesses that do not go away and often get worse over time. It is different from curative treatment. Palliative care can help you and your loved ones cope with an incurable disease. Colon cancer is usually something that can be cured, even if people go on worrying about it and have to be careful that it does not reappear.

Why would I want palliative medicine?

Palliative care focuses on improving quality of life in your body, mind and spirit. Sometimes palliative care is combined with curative treatment.

It is important to consider how palliative chemotherapy will affect your quality of life. Palliative chemotherapy can provide you with increased physical comfort and help give you a reasonably high functioning level and a strong support system for your emotional and spiritual health. But the chances are high you might:

• develop serious side effects,
• have ongoing treatments and tests
• become emotionally and spiritually drained.

Then, the likelihood of palliative chemotherapy improving your quality of life is probably poor.

Your goals guide your care. Palliative care can help reduce pain or treatment side effects. Palliative care may help you and your loved ones better understand your illness. It might enable you to talk more openly about your feelings, or decide what treatment you want or do not want. It can also make sure that your doctors, nurses, and loved ones understand your goals and are "on the same page."

Who is involved in palliative care?

Palliative care actively involves you and your loved ones. Together, you will work with health care providers in your doctor's office, home, hospital, nursing home or hospice. Your doctor may be able to manage your palliative care needs or refer you to someone who is trained in palliative care.

Palliative care providers are interested in what is bothering you and what is important to you. They want to know how you and your loved ones are doing day-to-day. They understand that your illness affects not just you, but also those you love.

Many hospitals now have palliative care teams. These teams include palliative care doctors, nurses, and social workers. The teams may also include:

• spiritual advisors
• dietitians
• occupational therapists
• pharmacists
• physical therapists
• respiratory therapists
• volunteers

How can I work with a palliative care team?

Good communication is a large part of palliative care.

Your palliative care providers will ask about how your illness affects your emotions and spirit. Then they will try to make sure that your medical care meets your goals for your body, mind, and spirit. They will also help you make future plans around your health and medical care.

Your palliative care providers will encourage you to listen to your feelings and to talk about what is most important to you. They will try to explain things to you and your loved ones in ways you can understand. They will work with your primary care doctor to make sure that your care is meeting your goals, such as managing disturbing symptoms or making future plans.

You may talk about anything and everything during a palliative care visit, including:

• Treatment
• Pain and medicine side effects
• Emotional and social challenges, such as helping your family get along better
• Spiritual concerns
• Goals and dreams
• Hospice care
• Advance directives

Advance directives are instructions to your doctor and loved ones about what kind of care you want if you become unable to speak for yourself.

You might see a palliative care provider just once or maybe more often. He or she will work with your other doctors to give you the best care possible.

How is palliative care different from hospice care?

In the past, palliative care was mostly used to treat people on hospice care. Hospice is a type of palliative care for people who are in their final weeks or months of life.

Palliative care is no longer just for people who are near death. Today, palliative care can help anyone who has an illness that may get worse over time. For example, you may want palliative care while you are getting treatment for heart failure. Palliative care could help you manage symptoms or side effects of treatment so that you will feel better.

Questions To Ask When Considering Palliative Care

In The Journal of the American Medical Association (JAMA), Drs. Thomas J. Smith and Sarah Elizabeth Harrington listed these questions to ask - of professionals and yourself. These questions consider that chemotherapy that is unlikely to cure the cancer but may extend the length and quality of life.

When considering palliative chemotherapy, talk to your doctor about the risks versus potential benefits. Gather as much information as you can about your cancer and the likely affect palliative chemotherapy will have on tumor size and quality of life.

There is no right answer for every cancer patient. Quality of life is deeply personal. Take time to examine your needs, desires, and the things that are most important to you.

Here are some important questions to ask your oncologist when considering palliative chemotherapy:

1. What is the Response Rate of the proposed palliative chemotherapy?
   Response Rate refers to the likelihood that your cancer will improve from the treatment. A Response Rate of 30% means that if 100 patients like you were treated, 30 patients would have their cancer shrink by one-half or more. For some cancers, the term response rate can be expanded to include those patients whose cancer did not shrink, but also did not grow. Talk to your oncologist to understand exactly how he/she is using the term response rate for your cancer.
2. What is the Median Duration of Response of the proposed chemotherapy?
   The Median Duration of Response tells you how long your cancer can be expected to respond to the chemotherapy, before the cancer starts growing again. For most cancers where palliative chemotherapy is used, this number ranges from 3-12 months. The longer the response, the longer you can expect to live.
3. What side effects can I expect?
   Although the treatment of chemotherapy side effects has vastly improved in the past 20 years, every patient responds differently. Ask your doctor to describe the most likely symptoms you will experience during chemotherapy treatment.
4. How long must I continue treatment?
   Standard practice is to wait for one-two full cycles of treatment (a typical cycle lasts 3-4 weeks) before looking at the cancer's response to it. If your cancer is responding to the treatment, your doctor will likely recommend continuing the chemotherapy until the cancer stops growing or you develop unacceptable side effects from the treatment.
5. What About Treatment and Prognosis?
   
   • What is my chance of cure?
   • What is the chance that this chemotherapy will make my cancer shrink? Stay stable? Grow?
   • If I cannot be cured, will I live longer with chemotherapy? How much longer?
   • What are the main side effects of the chemotherapy?
   • Will I feel better or worse?
   • Are there other options, like hospice or palliative care?
   • How do other people make these decisions?
   • Are there clinical trials available? What are the benefits? Am I eligible? What is needed to enroll?
   • What are the likely things that will happen to me?
   • How long will I live? (Ask for a range, and the most likely scenario for the period ahead, and when death might be expected.)
6. What Else Should I Plan For?
   
   • Are there other things I should be doing?
   • Should I prepare a will?
   • Do I have an advance directive?
   • Have I assigned a durable power of attorney for health care?
   • Are there financial or family legal issues that should be addressed?
   • Do I need a durable power of attorney for financial affairs?
   • Should I be setting up a trust?
   • Family issues: Will you help me talk with my children?
   • Spiritual and psychological issues: Who can help me cope?
   • Legacy and life review: What do I want to pass on to my family to tell them about my life?
   • Who will take responsibility for identifying any new care needs I may have, such as for pain or tiredness? Will someone also offer me and my family support?
   • Will I be able to talk to a palliative care consultant or a specialist palliative care nurse?
   • What do I do if I need help overnight or at a weekend?
   • Who do I go to first if I need help or have questions?
   • Who else can I talk t about how I am feeling? What support is available for my immediate family?
   • If I die, will I be able to die where I want?
   • If I die, who will offer my family support?

Final tips:

• Don't be afraid to ask these and other questions - it is your body, you have a right to know as much information as possible about your cancer and your treatment options.
• Seek out a second opinion if you feel you are not getting clear and honest information from your doctor.

Armed with the right information from your doctor and confidence in your personal goals, you'll be well-equipped to execute the decision that is right for you.

Additional Resources

• MyWhatever.com
• SupportiveOncology.net

Written by Deborah Theres - 4/30/09

Back to top