The field of medicine known as palliative care includes any treatment that is given to relieve symptoms caused by diseases such as cancer. While the main goal of medicine is to cure or control these diseases, there is an increasing need for attention and resources to be directed to addressing issues such as pain and symptom relief — conditions directly related to a patient's quality of life during treatment. More than twenty-five years ago, Memorial Sloan-Kettering Cancer Center was the first cancer hospital to create a pain and palliative care service. Today, the service continues to work to relieve, or palliate, the pain and distress that may be experienced by cancer patients — both those in active, curative treatment and those with advanced, late-stage cancers.
What Is Palliative Care?
Paul Glare, MD, Chief of the Pain and Palliative Care Service at Memorial Sloan-Kettering, defines palliative care as interdisciplinary treatment aimed at relieving suffering and improving quality of life, delivered simultaneously with all other appropriate treatments to patients with advanced illness and their families. Such care can be provided by physicians, nurses, pharmacists, mental health professionals, social workers, physical therapists, and chaplains.
“…we like to say that palliative care is about 'living better with cancer, not dying from it.'”
Paul Glare, MD, Chief of the Pain & Palliative Care Service
According to the National Comprehensive Cancer Network, cancer patients can receive palliative care if they experience issues such as fatigue, anemia, pain, distress, or nausea and vomiting, or if they or their family members have concerns about the course of the disease.
Dr. Glare explains that it is important to make a distinction between hospice, which provides end-of-life care for patients, and palliative care. “Palliative care is not hospice,” he notes. “What palliative care does is provide the relief of pain, discomfort, and distress, while a patient continues to receive disease-controlling treatment. In this sense, we like to say that palliative care is about 'living better with cancer, not dying from it.'”
Palliative Care: Now More Than Ever
According to the American Cancer Society, about 77 percent of all cancers are diagnosed in people 55 and older. By 2011, the first wave of baby boomers will turn 65. Because this population is expected to produce a significant increase in the number of people who will develop cancer, providing palliative care is becoming increasingly important. Currently, according to the Center to Advance Palliative Care, there are fewer than 3,000 doctors certified by the American Board of Hospice and Palliative Medicine, and only about 15,000 nurses accredited by the Hospice and Palliative Nurses Association.
In addition, issues related to adequate insurance reimbursement for palliative care need to be addressed. Contrary to popular belief, palliative care can actually reduce the cost of medical care. Studies have shown that access to palliative care produces shorter in-patient stays, lower hospital mortality, reduced cost of care, and fewer admissions to the intensive care unit.
Palliative Care at Memorial Sloan-Kettering
In Memorial Sloan-Kettering's interdisciplinary disease management model of treatment, each patient is treated by as many different specialists as are needed to address the various aspects of his or her disease. To further the active role of palliative care in cancer treatment at Memorial Sloan-Kettering, attending doctors from the Pain and Palliative Care Service have recently become active members of the disease management teams.
The Pain & Palliative Care Service's team includes individuals from specialties such as Interventional/Anesthesia Pain Management, Rehabilitation, Psychiatry and Behavioral Sciences, Integrative Medicine, Chaplaincy, Social Work, Pharmacy, the wound care team, radiation oncology, and neurology. These team members work together to improve the quality of life of patients as well as their families. “In addition to dealing with pain and other symptoms, these patients are worrying about what lies ahead for them,” Dr. Glare says. “They need to work out what their goals and priorities are for the rest of their lives. We can help them with all of that.”
In most cases, a patient's attending physician co-ordinates palliative care. The Pain and Palliative Care Service is consulted to assist with complicated cases and, if necessary, can address the issues on the pain and palliative care unit. In addition, palliative care is offered during outpatient visits and can be accessed after a patient is discharged. Recently, a walk-in palliative care clinic has been opened at the Rockefeller Outpatient Pavilion, Memorial Sloan-Kettering 53rd Street, on Tuesday and Thursday afternoons. This clinic provides pain and symptom control for patients with a physical condition that may become unstable and change abruptly, resulting in a life-threatening situation. The walk-in clinic also offers, when appropriate, counsel about transitioning patients to hospice care.
In collaboration with the Integrative Medicine Service, the Pain and Palliative Care Service plans to develop a cancer nutrition program, which will use nutritional intervention and a fitness program to address issues of pain and symptom control for patients experiencing anorexia-cachexia syndrome — a condition in which some patients with advanced cancer suffer from malnutrition, weight loss, and muscle weakness as a result of cancer and its treatment.
“Many patients with cancer can benefit from palliative care,” Dr. Glare notes. “Unfortunately, too few know of the palliative care options that are available to them. We need to do a better job of getting the word out so that these patients can be helped.”