When dealing with advanced cancer, patients have different goals for their care. These goals may change over time. Some patients want to keep trying aggressive treatments. Others decide to choose other paths for care, such as controlling the symptoms of the disease.

Decisions for care are very personal and it’s natural to want to do all you can. But you should weigh these feelings against the risks and benefits of available treatments as well as your own feelings about life and death. You should ask all the questions you need to. If you choose not to go through active cancer treatment, you will continue to receive care and be made comfortable.

Palliative Care

Palliative care is care that makes patients feel better but doesn’t treat the disease itself. Palliative care should begin when the cancer is diagnosed. It continues through treatment and beyond. Research shows that palliative care improves the quality of life of patients and family members. All patients have a right to comfort and quality of life throughout their care.

Palliative care is an approach to care that addresses the person as a whole, not just their disease. The goal is to prevent or treat, as early as possible, the symptoms and side effects of the disease and its treatment, in addition to any related psychological, social, and spiritual problems.  Palliative care is also called comfort care, supportive care, and symptom management. Patients may receive palliative care in the hospital, an outpatient clinic, a long-term care facility, or at home under the direction of a physician.

Palliative care is especially important if you choose to stop treating your cancer.

It includes:

• Treating or preventing cancer symptoms and the side effects caused by treatment
• Getting help with emotional and spiritual problems
• Addressing the practical concerns of patients and families

Palliative treatment: Many of the same methods that are used to treat cancer, such as medicines and certain treatments, can also be used to reduce pain or other symptoms, and help a patient feel more comfortable. In advanced cancer, palliative treatment may be given to help a person feel better, even if it isn’t intended to treat the cancer. For example, doctors may give chemotherapy to slow the growth of a tumor that is causing pain. Or surgery may be performed to remove a mass that is pressing on certain nerves and causing pain.

To receive palliative care, members of your health care team may be able to help. However a palliative care specialist/physician may be the best person to treat problems. Ask your doctor or nurse if there is a specialist you can see.

Often, palliative care specialists work as part of a multidisciplinary team that may include doctors, nurses, registered dieticians, pharmacists, chaplains, psychologists, and social workers. The palliative care team works in conjunction with your oncology care team to manage your care and maintain the best possible quality of life for you.

What issues are addressed in palliative care?

The physical and emotional effects of cancer and its treatment may be very different from person to person. Palliative care can address a broad range of issues, integrating an individual’s specific needs into care. A palliative care specialist will take the following issues into account for each patient:

• Physical.
  Common physical symptoms include pain, fatigue, loss of appetite, nausea, vomiting, shortness of breath, and insomnia.
• Emotional and coping.
  Palliative care specialists can provide resources to help patients and families deal with the emotions that come with a cancer diagnosis and cancer treatment. Depression, anxiety, and fear are only a few of the concerns that can be addressed through palliative care.
• Spiritual.
  With a cancer diagnosis, patients and families often look more deeply for meaning in their lives. Some find the disease brings them closer to their faith or spiritual beliefs, whereas others struggle to understand why cancer happened to them. An expert in palliative care can help people explore their beliefs and values so that they can find a sense of peace or reach a point of acceptance that is appropriate for their situation.
• Caregiver needs.
  Family members are an important part of cancer care. Like the patient, they have changing needs. It’s common for family members to become overwhelmed by the extra responsibilities placed upon them. Many find it hard to care for a sick relative while trying to handle other obligations, such as work, household duties, and caring for other family members. Uncertainty about how to help their loved one with medical situations, inadequate social support, and emotions such as worry and fear can also add to caregiver stress.These challenges can compromise caregivers’ own health. Palliative care specialists can help families and friends cope and give them the support they need.
• Practical needs.
  Palliative care specialists can also assist with financial and legal worries, insurance questions, and employment concerns. Discussing the goals of care is also an important component of palliative care. This includes talking about advance directives and facilitating communication among family member, caregivers, and members of the oncology care team.

Hospice Care

Hospice is a special type of care in which medical, psychological, and spiritual support are given to patients and their loved ones when cancer therapies can no longer control the disease. The goal of hospice is to help you live each day to the fullest by making you as comfortable and as symptom-free as possible. Choosing hospice care doesn’t mean that you’ve given up. It means that the treatment goals are different at this point. It also doesn’t mean that you, your family, or your health care team are giving up hope. Instead, hospice care means you are changing what you hope for.

Hospice care most often takes place at home, but it can also be provided in special in-patient facilities, hospitals, and nursing homes. It can also take place along with professional home care if necessary. Hospice services may include:

• Doctor and nursing services
• Medical supplies and equipment
• Drugs for managing cancer-related symptoms and pain
• Short-term inpatient care
• Volunteers to give caregivers a break
• Counseling and spiritual care
• Social work services
• Grief counseling and support

Hospice professionals and volunteers are specially trained.

They are dedicated to supporting the emotional needs of both patients and their families, and are trained to deal with medical symptoms. The goal of hospice care is to neither hasten nor postpone death. If your condition improves or the cancer goes into remission, hospice care can be stopped and active treatment may resume.

Hospice can provide support for months.

Even though many people believe that hospice is only available in the last days or weeks of life, it can provide support for months. Many people have said that they wished hospice care had begun earlier. They were surprised by the expert care and understanding that they got from hospice caregivers.

Contact your doctor or nurse to get information if Hospice care is available near you.

What is the difference between palliative care and hospice?

Whereas palliative can begin at any point along the cancer care continuum, hospice care begins when curative treatment is no longer the goal of care and the sole focus is quality of life.

Palliative care can help patients and their loved ones make the transition from treatment meant to cure or control the disease to hospice care by:

• preparing them for physical changes that may occur near the end of life
• helping them cope with the different thoughts and emotional issues that arise
• providing support for family members

Clinical Trials

Patients with advanced cancer may be offered the option to participate in clinical trials. These trials are designed to look at the safety of a new treatment.

The chance that the new treatment will benefit a patient in such a trial is low, but some patients join these trials because they have hope that the treatment may help slow the growth of their cancer. Another reason may be that they want to benefit future patients by taking part in a trial.

Clinical trials have both benefits and risks. Your doctor and the study doctors should fully explain these before you decide to join a trial.