Is palliative care the end of the road
The World Health Organisation describes Palliative Care as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness like cancer or other life limiting disease.
What is life-limiting disease?
A life-limiting disease is any disease where the condition cannot be cured. Good examples of life limiting diseases include the various kinds of cancer, those living with chronic kidney failure where kidney transplantation is not an option, people with chronic heart failure or advanced emphysema. Nowadays we also see many forms of progressive brain diseases like motor neuron disease that has no cure.
What is palliative care?
The word” palliative” comes from the ancient Latin word “palliare”. The meaning of” palliare” is “to cloak”. Historically doctors did not like to use the term palliative care because it seems to convey a message that the treatment toolbox is now empty and to provide only symptom relief “was perceived as cloaking the essence of the illness, smothering symptoms rather than attacking disease.”
The World Health Organisation describes Palliative Care as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness like cancer or other life limiting disease. That means that when the diagnosis is made, the palliative care approach starts. A good example is when cancer is diagnosed in a patient. After the full work-up of the patient, the doctor will decide, based on the type of cancer and whether it has spread, what the aim of treatment will be. If there is a realistic chance of cure based on research of different treatment options, the intent of treatment is to cure. If from the available knowledge and treatment options that are available, cure is unlikely, the treatment intent becomes palliative – in other words either to prolong life or in other cases to provide relief of symptoms and to provide comfort to the patient.
In palliative care with a cancer diagnosis, the care team may still include surgery, or chemotherapy or radiation therapy or a combination of the treatment modalities to achieve the aim either with the intention to prolong life or to provide comfort and relief of symptoms like pain. The treatment is adjusted in time as the condition of the patient improves or deteriorates. This means that the trajectory of palliative care could either be a journey that lasts for many years with good or relatively good health. In some instances, one must also be realistic where the illness, with time or due to a late diagnosis, has progressed and caused irreversible decline of the health and functioning of the patient. When diagnoses like cancer is made late and has already progressed into the final stages of life, the care will be focussed on comfort, symptom relief and support during the terminal stage of life and this care and support will also extend to the family of the patient and during terminal phase of the illness and also during their bereavement. . In these cases, the healthcare team will not hasten but will also not postpone death where there is no quality of life or where suffering will only be prolonged.
So, does palliative care mean the “end-of-the-road”?
Let us start with the biggest truth – as a principle palliative care affirms life and regards dying as a normal process. Given that statement, it means that if the doctor suggests that care from now on is palliative, and where appropriate, treatment to control the disease and improve quality of life will continue. It is NOT the end-of-the road. The reality is that most people who need palliative care are not dying. Many survivors of cancer cannot be cured but survives through the diligent follow-up and treatment of any progression of the disease. Thus, attaining the improvement that go with remission or control of progression which result in added years to life.
Take home message
There is HOPE of living. The palliative care process Intends to try to prolong quality and life where appropriate. It is a myth that palliative care means that there is no hope, and it is not a synonym for end-of-life care.
Dr Martin de Villiers is the Medical Director at Medwell SA – The Home Health Care Specialists. For more information on services available, visit www.medwell.co.za or send an enquiry to info@medwell.co.za
