Palliative Care for Cancer Survivors?

Betty R. Ferrell, PhD, RN

Disclosures

December 15, 2017

Palliative Care for Cancer Survivors

Palliative care can be helpful in addressing both symptom concerns and psychosocial issues in cancer survivors. Failure to address Monica's concerns will likely cause her concerns to continue and her anxiety to increase. Symptoms following cancer often persist for months to years. And although Monica may need the involvement of a mental health specialist, a referral to palliative care will provide the most comprehensive assessment of all of her physical and psychosocial needs.

Advances in the detection and treatment of cancer have resulted in the present population of more than 14 million cancer survivors in the United States.[1] An aging population, increased use of targeted therapies, and better supportive care through treatment mean that the survivorship population will continue to grow.

Extensive literature in the area of cancer survivorship has documented that many significant quality-of-life concerns continue after cancer treatment, including pain, fatigue, weight loss or gain, insomnia, anxiety, sexuality concerns, and other problems.[2] The Institute of Medicine and numerous professional and advocacy groups have endorsed the recommendation for survivorship care planning, so that cancer survivors can receive the care necessary to address these issues.[3]

In addition to the physical effects of treatment, many psychosocial and spiritual problems are associated with cancer survivorship. Patients struggle with the adjustment after cancer diagnosis and treatment and may experience depression, anxiety, survivorship guilt, the challenges of living with uncertainty, and spiritual or existential distress.[4]

The key principles of palliative care also apply to survivorship care.[5,6] Many cancer survivorship clinics now have relationships with palliative care teams or see patients concurrently in clinic settings. Palliative care can provide relief of distressing physical symptoms as well as psychosocial support. Unfortunately, palliative care is still too often viewed by patients or even some professionals as end-of-life care, which can be a real obstacle for the cancer survivorship population.

Furthermore, although many patients will be long-term survivors, others may experience recurrences or develop second malignancies or delayed treatment effects, such as cardiac or pulmonary complications following stem cell transplant, chemotherapy, or radiation. Early integration of palliative care with survivorship care can be a key to quality cancer care.

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