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THE NEED FOR PALLIATIVE CARE

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Despite significant progress in our understanding of cancer biology and the development of novel therapeutics, most patients with advanced cancer still die of their disease (1). In addition to the significant mortality, cancer contributes to significant morbidity for cancer patients and their families.

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The growth of cancer can result in multiple symptoms by direct invasion, obstruction, compression, inflammation, effusions, and paraneoplastic syndromes. Moreover, cancer predisposes patients to various complications, such as infections, bleeding, thrombosis, and fractures. Cancer treatments such as surgery, radiation, chemotherapy-targeted agents, and immunotherapy can also cause multiple adverse effects involving the cardiac, pulmonary, gastrointestinal, hematologic, musculoskeletal, neurological, endocrine, and dermatologic systems. Living with cancer also means that patients not only have to face their own mortality but also have to deal with many psychosocial stresses related to the uncertainties along the disease trajectory. They have to cope with changes in their bodily function, body image, ability to engage in daily activities, and family dynamics. Finally, many patients and families express significant existential issues and financial concerns. Taken together, the direct cancer effects, cancer treatments, and psychosocial issues all contribute to a large number of physical and psychological symptoms, resulting in a decrease in quality of life and increase in caregiver burden (2).

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The literature has consistently demonstrated that cancer patients, particularly those with advanced disease, experience an average of 8 to 12 symptoms (3,4), suggesting that many symptoms are underrecognized, underdiagnosed, and undertreated. In addition to physical, psychological, and existential concerns, patients and families often have informational and decision-making needs (4).

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Over the past few decades, palliative care has matured as a discipline that specializes in addressing the multidimensional care needs of patients and their families. Palliative care

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is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. … Palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.(5)

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The key domains of palliative care include the following: building relationships and rapport, assessing and managing symptoms, addressing coping, establishing illness understanding, discussing cancer treatments, discussing end-of-life planning, and engaging family members (6).

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Multiple studies have demonstrated improved patient outcomes associated with palliative care. In a meta-analysis, Higginson et al found that palliative care was associated with a significant improvement in pain (odds ratio [OR], 0.38; 95% CI, 0.23-0.64) and other symptoms (OR, 0.51; CI, 0.30-0.88) (7). Recent randomized controlled trials also demonstrated that palliative care ...

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