Palliative care, which aims to reduce symptoms and improve quality of life for people being treated for a serious illness, may offer benefits for early-stage cancer patients, experts say. Stage I, II or III tumors are typically considered early-stage cancers.
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Guidelines from the American Society of Clinical Oncology (ASCO) focus mainly on patients with advanced cancer. But the authors emphasize that palliative care may benefit early-stage patients in several key ways.
“Many people with early-stage disease have troublesome symptoms, including fatigue, constipation and post-surgical pain,” says Betty Ferrell, director of the Division of Nursing Research and Education at the City of Hope National Medical Center in Duarte, California, who co-chaired the ASCO guidelines panel. “There’s clear evidence that palliative care helps alleviate these issues.”
Ferrell led a study of non–small cell lung cancer patients published in the December 2015
Journal of Pain and Symptom Management that found palliative care interventions, which included physical, psychological, social and spiritual assistance, were more beneficial for patients with early-stage disease than for those with stage IV disease.
Early implementation of palliative care also can help stop the cascading effect of symptoms. “Nausea can lead to weight loss, which can lead to depression and so on,” Ferrell says. “But if we can get that first problem under control, we might be able to prevent the others.” She adds that early-stage patients may need just one appointment with a palliative care professional to fine-tune their medication regimen and make a connection with a care team in case symptoms worsen.
It’s critical for patients to be their own advocates when asking for palliative care and not depend solely on their oncologists, experts say. “Most oncologists are focused on cancer chemotherapy, and it might stretch the limits of their time, energy and knowledge to help patients manage difficult symptoms,” says ASCO panel co-chair Thomas Smith, director of Palliative Medicine at Johns Hopkins Medicine in Baltimore. “But patients need to know that there is an entire group of professionals who may be able to help.”
For most patients, adds Smith, “palliative care is like any other specialty consult and should be covered by insurance, just like seeing a geriatrician or a cardiologist would be.”
Ferrell says that there is currently a dearth of palliative care professionals, and teams are often stretched thin because they are called on to help manage illnesses besides cancer, such as heart failure. “There’s growing recognition that we need to train more oncologists and oncology nurses in basic palliative care techniques,” she says.
A barrier to getting care for early-stage patients is the common misperception that palliative care is the same as hospice care. “Patients and their caregivers think ‘not yet,’ ” Ferrell says. “But it doesn’t take long before they realize that this is all about helping them be more active and supporting them and their families.”
September 25, 2017