The importance of supportive and palliative care in cancer
When treating pain, it is not enough to only focus on the physical sensation of pain, but to also recognise the impact of the pain on the whole person, as well as how that person perceives pain and is able to cope or not cope with pain. This holistic assessment then allows for an approach to the management of pain as more than just the prescribing of pain medications.
Interestingly, when one examines what is important for maintaining hope with chronic illness, these very aspects such as a positive outlook, physical and psychosocial wellbeing, spirituality and faith, levels of support and family relationships as well as information about the condition or illness are all significant factors.
According to the World Health Organisation, “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
With supportive and palliative care, not only is one’s pain and other symptoms of illness managed, but the holistic approach is also important for fostering hope through what is a very difficult process for both the patient and the family.
The words “palliative care” may immediately conjure up images of death and dying for those who are familiar with the term. Many who start to read this may want to stop and move on; and I would not blame you for this reaction because unfortunately this perception has been perpetuated by early definitions of hospice and palliative care. You may be thinking: “But I am focusing on cure and getting well. I don’t need palliative care.” Early palliative care has been shown to improve quality of life, leads to less depression in persons with a life-threatening illness, may result in fewer hospital admissions and in some cases, even in late stages of the disease, appears to have extended life by weeks to a few months.
Palliative care is not only for the dying. It is a philosophy of care, which when applied to anyone diagnosed with a serious illness can improve his or her quality of life from the time of first diagnosis. At this time you are most likely to be anxious, perhaps in shock or afraid with your head full of endless questions. What is going to happen next? What will be the treatment? Will I survive? How do I make an informed decision about my treatment? Is it going to be painful? What are the side effects? “I know someone who suffered terribly.” What about my spouse, children, parents, friends? How do I deal with the uncertainty? What about my work? How do I recover and return to a “normal life?” What about the pain, the nausea and vomiting, maybe constipation, swelling or lymphoedema, fatigue, loss of appetite and much more? With a holistic approach by a multidisciplinary team, and with good communication, these issues and many more are addressed through palliative and supportive care.
Let’s look more closely at the issue of pain. According to the International Association for the Study of Pain, “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” This definition proposed in 1994, describes pain in clinical terms while acknowledging the emotional aspect of pain. However, Margot McCaffery, in 1968 already recognised that pain is more than just a clinical condition, the severity of which is not always appreciated by healthcare practitioners. She said “Pain is what the experiencing person says it is, existing whenever the experiencing person says it does.” This concept of the subjective experience of pain, which may be overlooked in the absence of any objective evidence of the severity of the pain, is understood by palliative care practitioners. It is illustrated by Dame Cicely Saunders’ concept of total pain, which defines the inter-relationships between the physical, emotional, social, cultural and spiritual aspects of pain and suffering.
The concept of Total pain
When treating pain, it is not enough to only focus on the physical sensation of pain, but to also recognise the impact of the pain on the whole person, as well as how that person perceives pain and is able to cope or not cope with pain. This holistic assessment then allows for an approach to the management of pain as more than just the prescribing of pain medications.
Interestingly, when one examines what is important for maintaining hope with chronic illness, these very aspects such as a positive outlook, physical and psychosocial wellbeing, spirituality and faith, levels of support and family relationships as well as information about the condition or illness are all significant factors.
According to the World Health Organisation, “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
With supportive and palliative care, not only is one’s pain and other symptoms of illness managed, but the holistic approach is also important for fostering hope through what is a very difficult process for both the patient and the family.
MEET OUR EXPERT – Dr Charmaine Blanchard
MPhil Pall Med, Dip Pall Med, MBBCh, BSc(Hons)Experience in medical practice in different settings: tertiary to primary levels of care in government
hospitals and clinics, as well as palliative care practice in private and NGO sectors. Until recently, I was the
director of the Centre for Palliative Care at Chris Hani Baragwanath Academic Hospital for four years and I enjoy teaching palliative care at Wits University.