Pain control for cancer and palliative care is used when pain and symptom control is important for quality of life. An integrated model of care to address the entire patient, body and mind, is the best approach. This may serve as a bridge to hospice care.
What Is Palliative Care
- Palliative care employs an interdisciplinary team to focus on relieving suffering in all stages of disease and is not limited to end-of-life care. This care may occur at the same time as curative or life-prolonging treatments.
- Palliative care is not hospice and doesn’t need to have a six-month-terminal-condition prognosis.
- The basic goal of palliative care is symptom management. The care team can typically better manage symptoms of pain, anxiety, shortness of breath, nausea, emesis, constipation, and diarrhea than the busy, multitasking provider.
- Palliative care providers continually strive to clarify the goals of treatment interventions and determine whether they are consistent with the values and decisions of the patient and with the reality of the disease process.
- Palliative care improves quality of life for the patient and their family.
- After serious illnesses, the primary care providers, friends, family members, nursing facilities, specialists, and also hospitalists refer patients to palliative care.
- For patients who have a terminal cancer condition and transition from palliative care onto hospice, the goal of treatment for cancer pain is to improve comfort (compared to the goal for treatment of CNCP to improve function). Escalating doses and high MEDs are not unusual in these circumstances. The risk/benefit balance is not the same as it would be in a patient with the expectation of years of productive life. Care must still be taken to ensure that your medication is going to your patient, and not being diverted.
Why Is Palliative Care Important
- Primary care management of pain and symptom relief in the pre-terminal and terminal patients may vary considerably between provider offices.
- PCPs may not have the training or experience to feel comfortable with symptom management, and their offices may not have the dedicated resources for integrated services.
- Palliative care teams are responsive to the questions and needs of the patient and families, and can serve as the eyes and ears for the provider.
- Palliative care can serve as a seamless transition to hospice care during the last six months of life. This benefits everyone.
Palliative Care Approaches
- Non-pharmacologic treatments may include electrical nerve stimulation and TENS units, therapeutic exercise, splints, and nerve blocks.
- Alternative or complementary therapies for pain may include psychological therapies (e.g., guided imagery, cognitive interventions), acupuncture, music therapy, massage, rehabilitation, and physical therapy, along with other mind-body approaches.
- Pharmacologic approaches to pain include the same medications as mentioned above in Pain Control in the Elderly, page 32.
- Novel uses of medications to manage a wide spectrum of symptoms may also be effective.
- Major depression is a treatable condition, even in terminally ill patients.
- Opioids are the mainstay of treatment for pain at the end of life.