From the Guidelines
A cancer patient can start palliative care at any point after diagnosis, even while still receiving curative treatment, as it has been shown to improve symptom management, reduce depression, enhance quality of life, and in some cases, even extend survival 1. Palliative care should ideally begin early in the disease course to effectively manage symptoms and improve quality of life. This specialized medical care focuses on providing relief from pain, symptoms, and stress of serious illness, and can include medications like morphine, oxycodone, or fentanyl for pain; ondansetron or prochlorperazine for nausea; and dexamethasone for inflammation. Some key points to consider when starting palliative care include:
- Palliative care is delivered by a multidisciplinary team including doctors, nurses, social workers, and chaplains who address physical, emotional, and spiritual needs.
- Early integration of palliative care has been associated with improved end-of-life outcomes and has been shown to positively impact end-of-life care trajectories 1.
- Palliative care consultations for patients with advanced cancer have also been shown to reduce the quantity and intensity of life-prolonging care received toward the end-of-life 1. Patients should discuss palliative care options with their oncologist soon after diagnosis to develop a comprehensive care plan that addresses their individual needs and goals.
From the Research
Eligibility for Palliative Care
- Cancer patients can start palliative care at any stage of their illness, as it focuses on providing relief from the symptoms and stress of a serious illness 2.
- The goal of palliative care is to improve the quality of life for both the patient and their family, and it can be provided alongside curative treatments.
Benefits of Early Palliative Care
- Early access to palliative care can improve symptom control, quality of life, and reduce the cost of care 2.
- Preliminary results also show that early palliative care access can extend survival, highlighting the importance of introducing it early in the treatment process.
Essential Drugs for Palliative Care
- A consensus among palliative care clinicians identified four essential drugs for symptom alleviation in the last 48 hours of life: morphine, midazolam, haloperidol, and an antimuscarinic drug 3.
- These drugs should be made available in all settings caring for dying patients with cancer to decrease the gap between knowledge and practice.
Pharmacokinetic Considerations
- The pharmacokinetics of drugs used in palliative care, such as morphine, midazolam, and haloperidol, may be altered in terminally ill patients due to physiological changes 4.
- Limited evidence exists on guided drug use in this population, and more knowledge and pharmacokinetic/pharmacodynamic studies are needed to develop individualized dosing guidelines.