COMMENTARY

Changing the Conversation: Palliative Care Does Not Necessarily Mean End-of-Life Care

Maurie Markman, MD

Disclosures

May 20, 2016

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Hello. I'm Dr Maurie Markman from Cancer Treatment Centers of America in Philadelphia. I wanted to briefly discuss a very important topic and two papers that appeared on the topic, which is palliative care among patients with cancer.

A very interesting paper recently appeared in the Canadian Medical Association Journal, entitled "Perceptions of Palliative Care Among Patients With Advanced Cancer and Their Caregivers."[1] This paper noted that the perceptions of palliative care—to quote the authors in the abstract—were of "death, hopelessness, dependency, and end-of-life comfort care for inpatients." Clearly, palliative care encompasses that group of patients who are in that particular situation. However, it is very clear that palliative care is intended to include patients at an earlier point in their journey. In fact, there is very strong evidence, including a landmark randomized phase 3 trial,[2] demonstrating that a palliative care approach can significantly improve survival by focusing on the palliative aspects of a patient's care, which includes pain management as well as other aspects of the palliation of symptoms.

There is a perception issue here that needs to be tackled head-on by the oncology and medical communities. However, the difficulty with that particular goal is heightened when one sees commentaries such as one that was recently published in the New England Journal of Medicine, entitled "Reducing the Risks of Relief--The CDC Opioid-Prescribing Guideline."[3] Clearly, the question of opioid overdose and addiction is very serious and needs to be taken very seriously by all physicians, including oncologists.

Yet, this particular document that appeared in the New England Journal of Medicine states, "[T]he guideline is designed to support clinicians caring for patients outside the context of active cancer treatment, or palliative or end-of-life care." Including palliative care within the idea of end-of-life care carries the connotation that, in fact, palliative care is end-of-life care and that, in the setting of palliating patients, you do not necessarily need to be concerned about other matters, such as one might in an individual who doesn't have advanced, progressive, and untreatable cancer.

The issue here is that we need to somehow change the conversation. The word "palliative" needs to be associated with focusing on a patient's symptoms rather than saying that "palliative" means end-of-life care. This is obviously a conversation that is important, and it's certainly relevant to optimizing the quality of life and the duration of life for patients with cancer at all stages, particularly advanced cancer. I hope that this conversation will become increasingly relevant within the oncology community as well as within the general medical community and the media and lay audiences, because palliative care is such an important part of the management of cancer patients. I thank you for your attention.

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