Palliative Care for Cancer Patients: An Interdisciplinary Approach

Robert S. Krouse

Disclosures

Cancer Chemother Rev. 2008;3(4):152-160. 

In This Article

Abstract and Introduction

Palliative care is increasingly recognized as an important component of quality care for cancer patients. Given an estimated 1,437,180 new patients diagnosed with cancer in the USA in 2008 , and approximately 565,650 cancer-related deaths, care for those patients who are near the end of life is an essential aspect of cancer care. Palliative care is an interdisciplinary team approach to care, with a focus on comfort and quality of life rather than prolongation of life or "cure" for a patient and their loved ones. Depending on the palliative care issue, many various treatments approaches may be available to manage symptoms and complications of advanced cancer. Common palliative care problems include pain, cachexia, asthenia, and wound issues. Examples of frequent concerns that necessitate an interdisciplinary team approach include pain, dyspnea, and malignant bowel obstruction. It is imperative to consider invasive or minimally invasive approaches in addition to noninvasive approaches for each of these problems. Each of these issues may mandate the expertise of specialists beyond the palliative care practitioner or medical oncologist, including surgeons, interventional radiologists, gastroenterologists, radiation oncologists, or anesthesiologists. Often there is a lack of high-quality research related to the optimal approach. The absence of an established evidence base in many areas of palliative care, at least in part due to the major challenges investigators face in designing palliative-care trials, emphasizes the need to involve other specialists in the care of these patients. In this way, the optimal approaches can be offered at this time of distress for patients and families.

Approximately 565,650 people die in the USA each year related to cancer.[1] Care for those patients who are near the end of life is an essential aspect of cancer care.[2] The World Health Organization (WHO) defines palliative care as "the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social, and spiritual problems is paramount. The goal of palliative care is achievement of the best QOL for patients and their families."[3] Quite simply, palliative care is treatment with the intent to improve the quality of life (QOL) for patients. Palliative care is an interdisciplinary team approach to care, with a focus on comfort and QOL rather than prolongation or "cure" for a patient. The goal of palliative care is to relieve suffering and to improve QOL.[4] In addition to curative treatment for cancer patients, recent years have seen a dramatic increase in a focus on palliative care. Although the past 10 years have seen impressive growth in palliative care research, this rate of growth appears to be particularly rapid for interventional research, including controlled trials of pain medications,[5,6] interventional procedures for pain,[7] and other nonpharmacologic interventions to improve a variety of aspects of end-of-life care.

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