Skip to main content
SpringerLink
Log in
Book cover

Supportive Cancer Care pp 77–95Cite as

Palliative Care

  • Chapter

  • 1016 Accesses

Abstract

From the words “you have cancer,” the life of an individual and their loved ones indisputably changes. Those few words have preconceived ideas of diagnosis, prognosis, treatment, and the “what now” questions moving forward. All of these concerns are legitimate and can be overwhelming. As much as healthcare providers may anticipate them, the discussions and symptom management are challenging for the providers, the patients, and their families. These challenging conversations continue to evolve along the cancer continuum. One such conversation may involve engaging the services of palliative care to better control symptoms, address concerns, and approach times of transition during the disease trajectory. It is not uncommon that the mere mention of palliative care evokes a sense of fear and hesitation in patients, families, and healthcare providers. Despite the growth of the field, the assumption remains that palliative care is synonymous with end-of-life care and that healthcare providers are giving up or abandoning all care, which is not the case. In the realm of oncology, palliative care is sometimes referred to as “supportive care.” It encompasses symptom management in the broadest sense involving multidisciplinary teams and both palliative and disease-specific services as needed, initiated concurrently and provided in parallel from initial diagnosis and symptom management into transitions of care toward survivorship or end of life and bereavement. The term “supportive care” is speculated to be less distressing to patients, and oncologists are more comfortable with the word “supportive” as opposed to “palliative.” Thus, “supportive care” resulted in earlier referrals to palliative care services and ultimately improved overall support and symptom management. When the palliative care program at the University of Texas MD Anderson Cancer Center was renamed supportive care, MD Anderson saw a significant rise in the number of referrals [1, 2]. Throughout this chapter, the terms palliative care and supportive care will be used interchangeably.

The original version of this chapter was revised. An erratum to this chapter can be found at DOI 10.1007/978-3-319-24814-1_20

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Bruera E, Hui D. Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care. J Clin Oncol. 2010;28(25):4013–7.

    Article  PubMed  Google Scholar 

  2. Rhondali W, Burt S, Wittenberg-Lyles E, Bruera E, Dalal S. Medical oncologists’ perception of palliative care programs and the impact of name change to supportive care on communication with patients during the referral process. A qualitative study. Palliat Support Care. 2013;11(5):397–404.

    Article  PubMed  Google Scholar 

  3. Saunders C. The evolution of palliative care. Patient Educ Couns. 2000;41(1):7–13.

    Article  CAS  PubMed  Google Scholar 

  4. von Gunten CF. Secondary and tertiary palliative care in US hospitals. JAMA. 2002;287(7):875–81.

    Article  Google Scholar 

  5. Hospice Philosophy Statement National Hospice and Palliative Care Organization. 11 Feb 2014. Available from: http://www.nhpco.org.

  6. Quill TE, Abernethy AP. Generalist plus specialist palliative care – creating a more sustainable model. N Engl J Med. 2013;368(13):1173–5.

    Article  CAS  PubMed  Google Scholar 

  7. Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting a consensus report from the Center to Advance Palliative Care. J Palliat Med. 2011;14(1):17–23.

    Article  PubMed  Google Scholar 

  8. Rangachari D, Smith TJ. Integrating palliative care in oncology: the oncologist as a primary palliative care provider. Cancer J (Sudbury, Mass). 2013;19(5):373–8.

    Article  Google Scholar 

  9. Bruera E, Hui D. Conceptual models for integrating palliative care at cancer centers. J Palliat Med. 2012;15(11):1261–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Han PK, Arnold RM. Palliative care services, patient abandonment, and the scope of physicians’ responsibilities in end-of-life care. J Palliat Med. 2005;8(6):1238–45.

    Article  PubMed  Google Scholar 

  11. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42.

    Article  CAS  PubMed  Google Scholar 

  12. Smith S, Brick A, O’Hara S, Normand C. Evidence on the cost and cost-effectiveness of palliative care: a literature review. Palliat Med. 2014;28(2):130–50.

    Article  PubMed  Google Scholar 

  13. Levit L, Balogh E, Nass S, Ganz PA. Delivering high-quality cancer care: charting a new course for a system in crisis. Washington, DC: National Academies Press; 2013.

    Book  Google Scholar 

  14. NCCN Guidelines Version 1.2014 Palliative Care 2014 [8-22-14]. Available from: www.nccn.org.

  15. Moss AH, Lunney JR, Culp S, Auber M, Kurian S, Rogers J, et al. Prognostic significance of the “surprise” question in cancer patients. J Palliat Med. 2010;13(7):837–40.

    Article  PubMed  Google Scholar 

  16. Greer JA, Jackson VA, Meier DE, Temel JS. Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA Cancer J Clin. 2013;63(5):349–63.

    Article  PubMed  Google Scholar 

  17. Ferris FD, Bruera E, Cherny N, Cummings C, Currow D, Dudgeon D, et al. Palliative cancer care a decade later: accomplishments, the need, next steps -- from the American Society of Clinical Oncology. J Clin Oncol. 2009;27(18):3052–8.

    Article  PubMed  Google Scholar 

  18. Clinical practice guidelines for quality palliative care. 3rd ed. National Consensus Project for Quality Palliative Care. Pittsburgh, PA; 2013.

    Google Scholar 

  19. Ong CK, Forbes D. Embracing Cicely Saunders’s concept of total pain. BMJ. 2005;331(7516):576.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Krikorian A, Limonero JT. An integrated view of suffering in palliative care. J Palliat Care. 2012;28(1):41–9.

    PubMed  Google Scholar 

  21. Ferris FD, Balfour HM, Bowen K, Farley J, Hardwick M, Lamontagne C, et al. A model to guide patient and family care: based on nationally accepted principles and norms of practice. J Pain Symptom Manage. 2002;24(2):106–23.

    Article  PubMed  Google Scholar 

  22. Mystakidou K, Tsilika E, Befon S, Kululias V, Vlahos L. Optimizing hospital-based home care for dying cancer patients: a population-based study. Palliat Med. 1999;13(5):385–92.

    Article  CAS  PubMed  Google Scholar 

  23. Mularski RA, Dy SM, Shugarman LR, Wilkinson AM, Lynn J, Shekelle PG, et al. A systematic review of measures of end-of-life care and its outcomes. Health Serv Res. 2007;42(5):1848–70.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Walsh D, Donnelly S, Rybicki L. The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients. Support Care Cancer. 2000;8(3):175–9.

    Article  CAS  PubMed  Google Scholar 

  25. Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer the Project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Yennurajalingam S, Urbauer DL, Casper KL, Reyes-Gibby CC, Chacko R, Poulter V, et al. Impact of a palliative care consultation team on cancer-related symptoms in advanced cancer patients referred to an outpatient supportive care clinic. J Pain Symptom Manage. 2011;41:49–56.

    Article  PubMed  Google Scholar 

  27. Bandieri E, Sichetti D, Romero M, Fanizza C, Belfiglio M, Buonaccorso L, et al. Impact of early access to a palliative/supportive care intervention on pain management in patients with cancer. Ann Oncol. 2012;23(8):2016–20.

    Article  CAS  PubMed  Google Scholar 

  28. Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383:1721–30.

    Article  PubMed  Google Scholar 

  29. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274(20):1591–8.

    Google Scholar 

  30. Spencer R, Nilsson M, Wright A, Pirl W, Prigerson H. Anxiety disorders in advanced cancer patients: correlates and predictors of end-of-life outcomes. Cancer. 2010;116(7):1810–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Oechsle K, Goerth K, Bokemeyer C, Mehnert A. Anxiety and depression in caregivers of terminally ill cancer patients: impact on their perspective of the patients’ symptom burden. J Palliat Med. 2013;16(9):1095–101.

    Article  PubMed  Google Scholar 

  32. Northouse L, Williams AL, Given B, McCorkle R. Psychosocial care for family caregivers of patients with cancer. J Clin Oncol. 2012;30(11):1227–34.

    Article  PubMed  Google Scholar 

  33. Gelfman LP, Meier DE, Morrison RS. Does palliative care improve quality? A survey of bereaved family members. J Pain Symptom Manage. 2008;36(1):22–8.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Meier DE. Increased access to palliative care and hospice services: opportunities to improve value in health care. Milbank Q. 2011;89(3):343–80.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Norton SA, Hogan LA, Holloway RG, Temkin-Greener H, Buckley MJ, Quill TE. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med. 2007;35(6):1530–5.

    Article  PubMed  Google Scholar 

  36. Lowery WJ, Lowery AW, Barnett JC, Lopez-Acevedo M, Lee PS, Secord AA, et al. Cost-effectiveness of early palliative care intervention in recurrent platinum-resistant ovarian cancer. Gynecol Oncol. 2013;130(3):426–30.

    Article  PubMed  Google Scholar 

  37. Campion FX, Larson LR, Kadlubek PJ, Earle CC, Neuss MN. Advancing performance measurement in oncology: quality oncology practice initiative participation and quality outcomes. J Oncol Pract. 2011;7(3 Suppl):31s–5.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Greer JA, Pirl WF, Jackson VA, Muzikansky A, Lennes IT, Heist RS, et al. Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol. 2012;30(4):394–400.

    Article  PubMed  Google Scholar 

  39. Walling A, Lorenz KA, Dy SM, Naeim A, Sanati H, Asch SM, et al. Evidence-based recommendations for information and care planning in cancer care. J Clin Oncol. 2008;26(23):3896–902.

    Article  PubMed  Google Scholar 

  40. Mack JW, Smith TJ. Reasons why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. J Clin Oncol. 2012;30(22):2715–7.

    Article  PubMed  Google Scholar 

  41. Butow PN, Dowsett S, Hagerty R, Tattersall MH. Communicating prognosis to patients with metastatic disease: what do they really want to know? Support Care Cancer. 2002;10(2):161–8.

    Article  CAS  PubMed  Google Scholar 

  42. Hagerty RG, Butow PN, Ellis PA, Lobb EA, Pendlebury S, Leighl N, et al. Cancer patient preferences for communication of prognosis in the metastatic setting. J Clin Oncol. 2004;22(9):1721–30.

    Article  PubMed  Google Scholar 

  43. Hagerty RG, Butow PN, Ellis PM, Lobb EA, Pendlebury SC, Leighl N, et al. Communicating with realism and hope: incurable cancer patients’ views on the disclosure of prognosis. J Clin Oncol. 2005;23(6):1278–88.

    Article  PubMed  Google Scholar 

  44. Peppercorn JM, Smith TJ, Helft PR, Debono DJ, Berry SR, Wollins DS, et al. American society of clinical oncology statement: toward individualized care for patients with advanced cancer. J Clin Oncol. 2011;29(6):755–60.

    Article  PubMed  Google Scholar 

  45. Murphy DJ, Burrows D, Santilli S, Kemp AW, Tenner S, Kreling B, et al. The influence of the probability of survival on patients’ preferences regarding cardiopulmonary resuscitation. N Engl J Med. 1994;330(8):545–9.

    Article  CAS  PubMed  Google Scholar 

  46. Keating NL, Landrum MB, Rogers Jr SO, Baum SK, Virnig BA, Huskamp HA, et al. Physician factors associated with discussions about end-of-life care. Cancer. 2010;116(4):998–1006.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Mack JW, Cronin A, Taback N, Huskamp HA, Keating NL, Malin JL, et al. End-of-life care discussions among patients with advanced cancer a cohort study. Ann Intern Med. 2012;156(3):204–10.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Christakis NA, Lamont EB. Extent and determinants of error in physicians’ prognoses in terminally ill patients: prospective cohort study. West J Med. 2000;172(5):310–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Back AL, Arnold RM. Discussing prognosis: “how much do you want to know?” talking to patients who are prepared. J Clin Oncol. 2006;24(25):4209–13.

    Article  PubMed  Google Scholar 

  50. Lorenz KA, Lynn J, Dy SM, Shugarman LR, Wilkinson A, Mularski RA, et al. Evidence for improving palliative care at the end of life: a systematic review. Ann Intern Med. 2008;148(2):147–59.

    Article  PubMed  Google Scholar 

  51. Moroni M, Zocchi D, Bolognesi D, Abernethy A, Rondelli R, Savorani G, et al. The ‘surprise’ question in advanced cancer patients: a prospective study among general practitioners. Palliat Med. 2014;28:959–64.

    Article  PubMed  Google Scholar 

  52. Vigano A, Dorgan M, Buckingham J, Bruera E, Suarez-Almazor ME. Survival prediction in terminal cancer patients: a systematic review of the medical literature. Palliat Med. 2000;14(5):363–74.

    Article  CAS  PubMed  Google Scholar 

  53. Morita T, Tsunoda J, Inoue S, Chihara S. Validity of the palliative performance scale from a survival perspective. J Pain Symptom Manage. 1999;18(1):2–3.

    Article  CAS  PubMed  Google Scholar 

  54. Subramaniam S, Thorns A, Ridout M, Thirukkumaran T, Osborne TR. Accuracy of prognosis prediction by PPI in hospice inpatients with cancer: a multi-centre prospective study. BMJ Support Palliat Care. 2013;3(3):324–9.

    Article  PubMed  Google Scholar 

  55. Epner DE, Baile WF. Difficult conversations: teaching medical oncology trainees communication skills one hour at a time. Acad Med. 2014;89(4):578–84.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Shanafelt T, Dyrbye L. Oncologist burnout: causes, consequences, and responses. J Clin Oncol. 2012;30(11):1235–41.

    Article  PubMed  Google Scholar 

  57. Moore PM, Wilkinson SS, Rivera Mercado S. Communication skills training for health care professionals working with cancer patients, their families and/or carers. Cochrane Database Syst Rev. 2004;(2):1–20.

    Google Scholar 

  58. Granek L, Krzyzanowska MK, Tozer R, Mazzotta P. Oncologists’ strategies and barriers to effective communication about the end of life. J Oncol Pract. 2013;11(5):1–7.

    Google Scholar 

  59. Back AL, Arnold RM, Baile WF, Tulsky JA, Fryer‐Edwards K. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005;55(3):164–77.

    Article  PubMed  Google Scholar 

  60. Buckman R. Practical plans for difficult conversations in medicine: Strategies that work in breaking bad news. Baltimore: Johns Hopkins University Press, Washington, DC; 2010.

    Google Scholar 

  61. Hallenbeck J. Palliative care perspectives. New York: Oxford University Press, Washington, DC; 2003.

    Google Scholar 

  62. Quill TE, Arnold R, Back AL. Discussing treatment preferences with patients who want “everything”. Ann Intern Med. 2009;151(5):345–9.

    Article  PubMed  Google Scholar 

  63. Olsen ML, Swetz KM, Mueller PS, editors. Ethical decision making with end-of-life care: palliative sedation and withholding or withdrawing life-sustaining treatments. Mayo Clinic Proceedings. Elsevier, Pittsburgh, PA; 2010.

    Google Scholar 

  64. Morita T, Inoue S, Chihara S. Sedation for symptom control in Japan: the importance of intermittent use and communication with family members. J Pain Symptom Manage. 1996;12(1):32–8.

    Article  CAS  PubMed  Google Scholar 

  65. Loggers ET, Starks H, Shannon-Dudley M, Back AL, Appelbaum FR, Stewart FM. Implementing a Death with Dignity program at a comprehensive cancer center. N Engl J Med. 2013;368(15):1417–24.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University of Arizona School of Medicine, 1609 N Warren Ave, Room 118, 245057, Tucson, AZ, 85724-5057, USA

    Suzanne M. Rhodes

  2. Wake Forest University School of Medicine, Section on Gerontology and Geriatric Medicine/Palliative Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA

    Jennifer Gabbard MD

  3. Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Fl, 33612, USA

    Ateefa Chaudhury MD

  4. Oregon Health and Science University, Mail Code VA P-3-GP1, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA

    Briana Ketterer MD

  5. Department of Palliative Medicine, Swedish Cancer Institute, Swedish Medical Center, 1221 Madison St. Suite 200, Seattle, WA 98104, USA

    Ellyn M. Lee MD, FACP

Authors
  1. Suzanne M. Rhodes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer Gabbard MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ateefa Chaudhury MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Briana Ketterer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ellyn M. Lee MD, FACP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ellyn M. Lee MD, FACP .

Editor information

Editors and Affiliations

  1. University of Arizona Cancer Center, Tucson, AZ, USA

    David Alberts , Maria Lluria-Prevatt  & Karen Weihs ,  & 

  2. University of Arizona Arizona Cancer Center, Tucson, AZ, USA

    Stephanie Kha

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Rhodes, S.M., Gabbard, J., Chaudhury, A., Ketterer, B., Lee, E.M. (2016). Palliative Care. In: Alberts, D., Lluria-Prevatt, M., Kha, S., Weihs, K. (eds) Supportive Cancer Care. Springer, Cham. https://doi.org/10.1007/978-3-319-24814-1_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-24814-1_5

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-24812-7

  • Online ISBN: 978-3-319-24814-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation