Palliative Care

What is the difference between palliative care and hospice care?

Although these terms are often used interchangeably, their meaning is not the same:^1,3

• Palliative care can be provided throughout a patient's treatment and at all stages of illness. It is an extra layer of support, alongside standard medical care, to make patients as comfortable as possible.
• Hospice care is a form of palliative care given to patients with a terminal illness who have a life expectancy of six months or less and who have decided to forgo curative treatment.

Who should receive palliative care?

Any patient who suffers from pain, stress, or other symptoms due to a serious illness, such as lung cancer, should receive palliative care.

The American Society of Clinical Oncology (ASCO) recommends that all patients with advanced cancer receive palliative care early on and concurrent with cancer treatment.³ The National Comprehesive Cancer Network (NCCN) recommends that cancer patients (along with their families and caregivers) should be made aware that palliative care is part of the patient's comprehensive cancer care.⁴ 

How are patients referred for palliative care?

Usually the primary care doctor or specialist managing the patient's disease will make the referral to a board-certified palliative care specialist. Patients should themselves request a referral if the doctor does not bring it up. A hospital social worker can also help patients and their families select a palliative care provider. While many private insurance plans, as well as Medicare and Medicaid, cover at least some palliative care services, patients should discuss what services are provided with their insurer in advance. Patients without health insurance should check with a social worker or their hospital's financial counselor.¹

Who provides palliative care?

Palliative care can be provided in a doctor’s office, hospital, cancer center, long-term care facility, or the patient's home. Social workers and patient navigatorsSomeone who provides personal guidance to patients as they move through the health care system can help with many of the emotional and practical issues. In addition, some doctors and advanced practice nurses specialize in palliative care. Many large hospitals and cancer centers have teams of palliative care doctors, nurses, social workers, therapists, and chaplains who work together to provide care alongside the oncologist. If the hospital or outpatient facility does not have a palliative care team, a patient's primary care doctor or specialist can refer the patient to a palliative care doctor outside the facility. (Note that a palliative care doctor never replaces any other doctors on the patient's healthcare team.) ^1,3

What specific issues can palliative care address?

The diagnosis of a serious disease and its treatment raises issues that affect all areas of a patient’s life (as well as most areas of the lives of their family members/caregivers). The palliative care team is able to focus on these issues. Below are lists with examples of issues and how they might be treated by the palliative care team. These lists are by no means comprehensive. Patients should feel free to bring up any issue with their palliative care team.^1,3,4

Physical symptoms or side effects

• Pain
• Trouble sleeping
• Shortness of breath
• Nausea, loss of appetite

Palliative care treatments may include:

• Medicine (pain relievers, chemotherapyTreatment with drugs that kill cancer cells to decrease the size of a tumorAn abnormal mass of tissue that results when cells divide more than they should or do not die when they should)
• Other medical treatments (radiationThe use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors or surgery to decrease the size of a tumor)
• Nutrition counseling
• Physical therapy
• Complementary therapies (massage, guided imagery, acupuncture)

Emotional problems

• Stress of the illness leading to fear, anxiety, hopelessness, anger, or depression
• Intimacy issues
• Helping caregivers balance their roles and duties and find support

Palliative care treatments may include:

• Counseling
• Support groups
• Family meetings
• Referrals to mental health providers

Practical problems

• Money or employment difficulties
• Child care worries
• Insurance questions
• Legal issues

The palliative care team may:

• Explain complex medical forms
• Help patients and families understand diagnosis and treatment choices
• Refer families to financial counseling and financial assistance resources
• Help connect patients and families to resources for transportation, housing, and other community resources

Spiritual issues

• Looking for meaning in life
• Questioning one's faith

The palliative care team may:

• Help patients and families explore their beliefs and values so they can find peace or move toward acceptance

What benefits can palliative care have?

Research has shown that starting palliative care at the time of diagnosis of cancer can result in:^1,3,4,5

• Better quality of life
• Reduction in intensity of symptoms and side effects
• Lower rates of depression
• Improvement in patients’ understanding of their prognosisThe likely outcome or course of a disease; the chance of recovery or recurrence
• Better clarification in treatment preferences and goals of care
• Decrease in acute care services (emergency department visits and hospital admissions)
• Longer survival