Palliative Care, Hospice, and End of Life

Abstract

Cancer is a deadly disease, but the treatments for cancer are toxic, debilitating, and, all too often, ineffective. Universally, therefore, suffering, both physical and psychological, is integral to the cancer patient experience. Palliative care is a supportive therapy that is directed toward lessening the suffering of cancer patients. It operates in parallel with disease-directed therapy to help preserve the cancer patient’s quality of life to the greatest degree possible, whether or not the disease-directed therapy is able to increase their quantity of life. Palliative care is patient-directed therapy. It addresses the personal needs of the patient but also provides support to families and caregivers. In order to meet the broadest range of needs, palliative care is inherently cross-disciplinary and wide-ranging. It addresses problems ranging from the physical to those of a psychosocial or spiritual nature. This type of care should begin with the patient’s diagnosis and follow through the patient’s entire course, providing what is needed at every phase. When the probability of increasing the patient’s quantity of life with disease-directed treatment is or becomes low to naught, palliative care may follow the patient into hospice care, where all disease-directed therapy is discontinued. With hospice care, all efforts are directed toward the quality of the patient’s remaining life and the quality of their death. Although rational, ethical, and medically sound, palliative care is widely underutilized. Instead, with little to no medical justification for doing so, futile disease-directed treatment of cancer patients often continues inappropriately up to the last weeks of a patient’s life. This chapter discusses the importance of and the need for palliative care for all cancer patients and, for patients with advanced, untreatable disease, the value of hospice and end-of-life support.