Information on Palliative Care

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Most cancer patients experience symptoms caused by the disease or its treatments. Research shows that these symptoms, which include fatigue, pain, poor sleep, depression, lack of appetite, and weight loss, usually are not treated adequately.

Often, cancer patients do not seek help for these symptoms and accept them as an unavoidable part of cancer. They sometimes feel that admitting symptoms is a sign of weakness. But uncontrolled physical or emotional symptoms can lead to increased suffering and decreased functioning and quality of life. They also can compromise a patient's ability to receive further cancer treatments.

Palliative care helps patients lessen and cope with symptoms caused by cancer and its treatment. The goal of palliative care is to prevent and relieve the suffering of cancer patients and to support the best possible quality of life for them and their families. This module explains how and when to use the range of medical treatments and other kinds of help that are considered to be palliative care.

  1. What is palliative care?
  2. How can palliative care help cancer patients and their families?
  3. When should palliative care begin?
  4. Does palliative care mean a patient cannot be cured?
  5. Who provides palliative care?
  6. What is the difference between palliative care and hospice care?
  7. How can palliative care help near the end of a patient's life?
  8. How can I find more information about palliative care?
  9. What is palliative care?

    The World Health Organization defines palliative care as care focused on patients with life-threatening diseases. Palliative care can begin at any time after the diagnosis of cancer is made, regardless of the patient's age, stage of cancer, and treatment plans.

    Palliative care is not necessarily end-of-life care. End-of-life care is a type of palliative care. If the patient's cancer cannot be treated, then the palliative care focus shifts to end-of-life care, which is often provided by hospice.

    How can palliative care help cancer patients and their families?

    Palliative care can help cancer patients by providing:

    • Treatment of pain and other physical symptoms, such as fatigue, nausea, constipation, poor sleep, loss of appetite, and weight loss
    • Treatment of emotional symptoms, such as depression and anxiety
    • Advice on medical decisions that respect the patient's goals and beliefs
    • Help with advance directives, documents that record the patient's choices for artificial life support and who should make medical decisions if he or she cannot do so
    • Transition to hospice care if appropriate
    • The palliative care team can help families and loved ones with emotional issues or advice on caring for the patient.

      This section includes information on how palliative care can help with:

      • Breathing difficulties
      • Depression and anxiety
      • Fatigue
      • Insomnia
      • Nutrition and eating challenges
      • Pain
      • Breathing difficulties

        Cancer patients sometimes have shortness of breath or difficulty breathing. This can be caused by:

        • Pain
        • Blocking of the throat or other part of airway by the cancer
        • Pneumonia or other infection
        • Lung diseases, such as emphysema, and other diseases
        • Anxiety
        • Side effects of cancer treatment
        • Ways to help patients with breathing problems include:

          • Controlled breathing techniques
          • Relaxation or visualization
          • A fan blowing in the room or on the patient's face
          • Additional oxygen through a tube in the nose
          • Medicine to decrease pain and anxiety
          • Assisted ventilation (use of a machine that helps a person breathe) sometimes can help cancer patients with breathing problems. If a person is approaching the end of life, assisted ventilation may be replaced with medicine for pain and other symptoms.

            The palliative care team can help by answering questions about breathing difficulties and finding the most appropriate treatment.

            Depression and anxiety

            Many patients with cancer feel some depression, anxiety, or both.

            Depression

            If you have cancer, it's natural to feel "blue" or "down in the dumps" sometimes. But if this feeling lasts every day for two weeks or more, or if it stops you from doing things you want or need to do, speak to your doctor or a member of your palliative care team. If you have suicidal thoughts, talk to your doctor or other healthcare professional as soon as possible.

            Patients with depression may:

            • Feel sad or cry a lot
            • Feel guilty, unworthy, or helpless
            • Have a negative outlook on the future
            • Lose interest in activities once enjoyed
            • Withdraw from friends and family
            • Be irritable and have a tendency to overreact
            • Have difficulty falling asleep or sleep too much
            • Anxiety

              Anxiety is a feeling of apprehension or nervousness. If you have anxiety, you may have:

              • Tense, worried, or restless feelings
              • Irregular or fast heartbeats, chest pain, or sweating
              • Difficulty concentrating
              • Feeling of suffocation
              • Rapid, difficult breathing
              • A number of treatments may help people who are depressed or anxious feel better. These include:

                • Medicines
                • Psychotherapy, counseling, or support groups
                • Exercise
                • Relaxation techniques
                • Fatigue

                  Most cancer patients feel fatigue because of their cancer or treatment. They may feel a deep exhaustion of body and mind that goes on for a long time, even after resting or sleeping. This may stop them from doing many of their normal activities and may make some of the other side effects of cancer, such as depression and pain, even worse.

                  Fatigue may be caused by:

                  • Pain
                  • Emotional stress/lack of sleep
                  • Infection
                  • Low red blood cell counts
                  • Inactivity
                  • Advanced cancer or cancer treatment
                  • Difficulty breathing
                  • Fatigue is a normal part of cancer and cancer treatment, and it does not mean you are lazy or weak. Discuss your fatigue with your doctor or palliative care team. Many methods can help with fatigue, including:

                    • Healthy diet
                    • Regular exercise
                    • Saving energy for times when you need it most
                    • Setting realistic and reachable goals
                    • Relaxation techniques
                    • Blood transfusion
                    • Medicine
                    • Insomnia

                      Insomnia means not getting enough sleep, having difficulty falling and staying asleep, or having interrupted or poor-quality sleep. About half of patients with advanced cancer have sleep problems.

                      Insomnia may be caused by pain, anxiety or depression, medicines, or the cancer. Before insomnia can be treated, its cause must be determined.

                      If you have insomnia, you may want to try the following:

                      • Maintain as regular a sleep schedule as possible.
                      • Avoid unnecessary time in bed during the day.
                      • If you are confined to bed, receive as much cognitive and physical stimulation during the day hours as possible.
                      • Nap only as necessary and avoid napping in the late afternoon and evening.
                      • Keep as active a daytime schedule as possible. (This should include social contacts and light exercise when able.)
                      • Avoid lying in bed for prolonged periods at night in an alert and frustrated or tense state. Read or engage in other relaxing activities out of bed until drowsy.
                      • Avoid stimulating substances (caffeine or nicotine), particularly in the hours before bedtime.
                      • Maintain adequate pain relief through the night.
                      • Nutrition and eating challenges

                        Good nutrition can help a cancer patient feel better and stronger. Sometimes it becomes difficult to eat a balanced diet because of depression, anxiety, fatigue, nausea, or physical problems like dry mouth or abdominal bloating. The palliative care team can look for ways to treat those problems and can recommend the best foods to eat.

                        As a person approaches the end of life, sometimes the body cannot use food. Then the palliative care team can help the patient and loved ones make decisions about whether to stop nutrition.

                        Tips to help with loss of appetite:

                        • Eat small, frequent meals.
                        • Eat larger quantities of food in the morning.
                        • Avoid spicy foods and food aromas.
                        • Try to make food a pleasurable social event and not a necessity.
                        • Encourage the eating of favorite foods.
                        • Resist the desire to force-feed. This may cause other problems.
                        • Pain

                          Pain is a common problem in cancer and cancer treatment. At least one third of people being treated for cancer have pain. The pain is usually a direct effect of the tumor on tissues, nerves, or bone. Sometimes radiation therapy or chemotherapy causes pain. Anxiety or delirium sometimes increases the perception and expression of pain.

                          In most cases, pain can be controlled with medicine. It is important for you to talk to your doctor about your pain and how the medicines make you feel. Each person's pain is different, and you may need to try several medicines or methods before you find what best controls your pain.

                          Pain medicine may be:

                          • Liquids or pills that are swallowed
                          • Suppositories that are inserted into the rectum
                          • Patches that are applied to the skin
                          • Injections in the skin, muscle, or vein
                          • Some cancer patients are afraid to take pain medicine because they think they may become addicted to the medicine. However, it is rare for people with cancer to become addicted to pain medicine.

                            Occasionally, pain is not relieved by medicine. If this happens, other methods such as radiation treatment, nerve blocks, or implanted pumps or surgery may be needed.

                            In addition to medicine, your doctor and palliative care team may be able to help you control or cope with your pain in other ways such as exercise, diet, or relaxation techniques.

                            When should palliative care begin?

                            Palliative care can begin at any time after cancer is diagnosed, regardless of the patient's age, the stage of cancer, or whether the patient is receiving cancer treatments.

                            Palliative care can be provided whenever a cancer patient has the need or desire to reduce suffering caused by symptoms such as pain, fatigue, breathing difficulties, depression, anxiety, or lack of sleep. These symptoms are common and can occur at any time after cancer is diagnosed.

                            Does palliative care mean a patient cannot be cured?

                            Many people believe that palliative care is only for patients whose cancer cannot be treated or who are close to the end of life. In fact, palliative care is most useful when it is started early, along with the cancer treatment. This way it can help treat common symptoms caused by treatment and ensure the best quality of life and success of treatment. For this reason, palliative care is often referred to as supportive care or symptom control.

                            Patients whose cancer cannot be treated often receive hospice care. Hospice care is a type of palliative care that is focused on end-of-life issues.

                            Who provides palliative care?

                            A team of specially trained doctors, nurses, social workers, and counselors usually provides palliative care.

                            These healthcare professionals know that cancer and its treatment can be overwhelming for patients, and they are aware of the many symptoms, such as pain, fatigue, and emotional changes. Also, they know that cancer alters the lives of patients and their families, and they understand the effect cancer can have on relationships and finances.

                            This team approach helps to make sure that all the concerns of cancer patients and their families are addressed.

                            What is the difference between palliative care and hospice care?

                            The goals of palliative care and hospice care are the same: to relieve pain and suffering and to improve the quality of life. However, the patients who receive the care are different.

                            Palliative care helps cancer patients and their families at any time during the illness, starting when cancer is diagnosed. It can be given along with cancer treatment, and it can continue after cancer treatment is completed. Palliative care usually is provided in the hospital, the doctor's office, a clinic, or the patient's home. Some patients receive palliative care for years.

                            Hospice care is a type of palliative care that is focused on the end of life. It is for patients whose cancer cannot be treated. For a patient to be eligible for hospice services, the doctor must certify that the patient is expected to live six months or less.

                            Hospice care can be given at the patient's home, in the hospital, in assisted-care living, or in a nursing home. Some hospice organizations have facilities where patients can stay for a short time for treatment of uncontrolled symptoms or to provide a break for the relatives or friends who have been caring for the patient.

                            How can palliative care help near the end of a patient's life?

                            Every person is different, and every person has different needs and feelings as his or her last days approach. Palliative care can help the patient and the family:

                            Prepare for the details of death. The patient and family may want to discuss certain details, such as a will and funeral arrangements, so the patient can make choices about important decisions. The conversations may be difficult, and the palliative care team can help by providing information and resources. The team can also provide forms for advance directives, which state the patient's wishes about life support and other end-of-life decisions.

                            Deal with feelings about death, whether they are anger, sadness, fear, or other emotions. If necessary, a social worker or therapist can help family members discuss their feelings.

                            Find ways to feel better spiritually and emotionally. This may include talking, consulting a minister or other religious adviser, looking at photographs, listening to music, or writing in a journal.

                            Decide if end-of-life care can be provided in the home or if the patient should be moved to a special facility. If the patient is to remain at home, the team can help the caregiver decide whether to begin hospice care. They also can recommend resources.

                            Keep the patient comfortable by treating pain, fatigue, breathing difficulties, and other problems.

                            How can I find more information about palliative care?

                            If you think you could benefit from palliative care, speak to your doctor or other healthcare professional. The following resources are a few of many that provide information on palliative care.

                            • American Cancer Society
                            • National Cancer Institute
                            • Partners Against Pain
                            • International Association for Hospice and Palliative Care
                            • More information on palliative care is available at these websites recommended by the U.S.News & World Report library:

                              ClinicalTrials.gov: Palliative Care: The NIH maintains ClinicalTrials.gov, a research database of federally and privately supported clinical trials. For more information, see the clinical-trials Resource Information page.

                              Caring Connections: Caring Connections, from the National Hospice and Palliative Care Organization, provides myriad resources on care and end-of-life issues. The site is broken up into areas for those planning ahead, those caring for someone, those living with an illness, and those grieving a loss.

                              Get Palliative Care.org: This new resource from the Center to Advance Palliative Care includes FAQs, steps to getting palliative care, stories, and links to additional resources. It also provides E-mail alerts and a one-page PDF file, "What should you know about palliative care?"

                              Palliative Care Policy Center (PCPC): The PCPC site offers caregiver guides and excerpts from the book Handbook for Mortals: Guidance for People Facing Serious Illness, as well as a megasearch of end-of-life care resouces.

                              FamilyDoctor.org: Cancer: Palliative Care: Operated by the American Academy of Family Physicians, this lengthy page (which is also available in Spanish) describes palliative care, where it is provided, how it can relieve pain and other symptoms, and how it prepares patients and family members for the end of life.

                              Last reviewed on 7/21/09

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