PALLIATIVE CARE – Purposes, Dimension, Types, Causes, Management
‘Palliative’ is derived from the root word ‘Pallium’ - a Latin word, meaning ‘cloak’ or ‘cover’. Palliative care is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than striving to halt, delay, or reverse progression of the disease itself or provide a cure. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness. Non-hospice palliative care is not dependent on prognosis and is offered in conjunction with curative and all other appropriate forms of medical treatment.
Palliative care is any form of treatment that concentrates on reducing a patient’s symptoms, improving quality of life, and supporting patients and their families. People with cancer often receive curative therapy and treatment to ease symptoms at the same time. And, there may be times when the treatment is focused on the management of symptoms.
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.
PURPOSES OF PALLIATIVE CARE
The goals of palliative care include:
- Treating distressing symptoms including pain, nausea, breathlessness, insomnia and other physical symptoms caused by cancer or its treatment
- Addressing a person’s spiritual needs or concerns
- Addressing a person’s practical needs, such as transportation and financial concerns
- Treating a person’s emotional and social needs which include symptoms such as anxiety or helping with difficult family relationships.
- Providing support for the patient’s family, friends, and caregivers
DIMENSIONS OF PALLIATIVE CARE
Palliative care is holistic care that includes four aspects – ‘knowing’, ‘feeling’, ‘feeling’, ‘being’ and ‘doing’ – all this to fulfill the needs of the dying. Holistic care is all about meeting the various needs of the patients:
- Physical needs: These differ according to the disease and the stage of the disease. Palliative care makes sure that that the patient never falls short of quick and efficient symptom control, and gets the benefits of state-of-the-art knowledge of medicine, surgery and radiotherapy is a must.
- Psychological needs: From safety to self-esteem to a sense of understanding, patients need to feel secure. Palliative care helps them preserve a sense of worth and self-esteem
- Social needs: The patients need to feel accepted, belonging and disengaged. They are not a burden, but are needed and connected.
- Spiritual needs: These patients need love, reconciliation, a sense of self worth and purpose. They need to give and forgive, end quarrels and depart with a calm and quiet frame of mind.
SYMPTOMS MANAGED THROUGH PALLIATIVE CARE
Some of the common symptoms managed through palliative care include:
Pain
Many people with cancer fear pain and, at the same time, believe it to be an unavoidable part of the disease. Statistics show that 30 to 40 percent of patients in active cancer therapy, and 70 to 90 percent of patients with advanced cancer report pain. Pain management is one of the most important aspects of palliative care. Many people with cancer experience pain.
TYPES OF CANCER PAIN
Nociceptive pain is caused by damage to tissue. Nociceptive pain originates from bone, joints, muscles, skin, connective tissues or viscera/organs such as liver, pancreas or intestine. It is usually described as a sharp, aching or throbbing pain
Neuropathic pain occurs when there is actual nerve damage. Neuropathic pain originates from either the central or the peripheral nervous system and is usually described as a burning or heavy sensation, or numbness.
CAUSES OF PAIN
Pain has many causes in people with cancer, including:
- Pain from the tumor: Most cancer pain occurs when a tumor presses on bone, nerves, or body organs and may vary according to location, (i.e., a small tumor pressing on a nerve or vital organ may cause severe pain, while a larger tumor elsewhere may cause little discomfort.
- Pain from cancer treatment: Cancer treatments, including surgery, chemotherapy, and radiation may also cause pain. Painful conditions are more likely to occur in patients whose immune system has been suppressed as a result of these therapies.
- Pain from other causes: Like everyone else, cancer patients have pain that has no relationship to their illness. Headaches, muscle strains, or other aches and pains associated with arthritis, kidney stones, etc., may cause pain, too. These conditions can normally be treated along with cancer pain.
MANAGEMENT
In most cases, pain can be controlled through medications prescribed according to the World Health Organization’s Analgesic Ladder, an approach using various levels of medication based on the severity of pain. This type of pain treatment, using drugs, is called pharmacological therapy. Medications may include non-opioid pain relievers (acetaminophen, aspirin and ibuprofen), opioid pain relievers (morphine, fentanyl, hydromorphone, oxycodone, meperidine, codeine, and methadone), adjuvant medications (corticosteroids, anti-depressants, anticonvulsants, antihistamines and amphetamines) and topical treatments such as patch, gel, or cream.
Non-pharmacological therapies, those that do not rely primarily on medication to achieve effect, include therapeutic exercise, cuteneous stimulation via application of superficial heat or cold, massage, pressure and vibration and cognitive behavioral techniques such as deep breathing, muscle relaxation, imagery, meditation, biofeedback therapy, and distraction.
Complementary and/or alternative approaches include acupuncture and massage therapy. Integrative medicine refers to the combination of mainstream conventional treatment such as surgery, chemotherapy and radiation with complementary therapies proven to have sound scientific evidence as to their safety and effectiveness.
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy that varies in degree, frequency and duration. Cancer-related fatigue may be result of the general progression of the disease, the effects of medication, or the after effects of treatments such as surgery, chemotherapy, or radiation therapy. Fatigue remains one of the most overlooked and under-treated side effects of having cancer, although it has a profound effect on the lives of cancer patients. Cancer itself can cause a great deal of fatigue, and a loss of energy is one of the major side effects of most forms of cancer treatment
Causes of Fatigue
Fatigue is caused by a variety of medical and physical conditions and psychosocial factors. These factors include:
- Anemia
- Major organ dysfunction, including heart and lung disease, and liver or kidney failure
- Hypothyroidism or adrenal problems
- Neuromuscular disorders
- Malnutrition, infection, dehydration, or salt imbalances
- Sleep disorders, immobility and lack of exercise
- Chronic pain or pain medication
- Anxiety, depression and stress
SYMPTOMS
The following symptoms are usually associated with fatigue:
- Diminished energy level disproportionate to activity
- Diminished activity associated with physical or intellectual performance
- Diminished motivation; lack of interest in activities
- Exhaustion, apathy, or lethargy
- Generalized tiredness
- Sleep abnormalities
- Irritability, impatience or changes in mood
MANAGEMENT
The treatment of fatigue is based on first identifying, and then managing, the underlying cause of the fatigue. Once that is accomplished, interventions such as medication, exercise, stress management and nutrition are used.
- Treating Anemia: Anemia (below-normal levels of red blood cells) can be a major factor in cancer-related fatigue. Lack of red blood cells and oxygen in the body creates an energy deficit, causing tiredness or fatigue. Blood transfusion therapy, as well as recombinant human erythropoietin (a hormone produced by DNA technology), is used to treat anemia. Erythropoietin stimulates bone marrow to produce red blood cells, thereby increasing the number of red blood cells in the body.
- Exercise: Moderate exercise has been found to relieve fatigue symptoms in both healthy people and those with chronic diseases. Light to moderate exercise, as recommended by a physician, can gently energize a patient and increase function. Exercise differs from casual, everyday activity, in that an exercise program is a controlled therapeutic activity used to maintain energy and minimize fatigue. Exercises should involve rhythmic and repetitive movement of large muscle groups (such as walking, cycling, or swimming). These exercises should begin gradually, several days a week, and should not be performed to the point of exhaustion
- Adequate Nutrition and Hydration: A balanced diet that combines adequate caloric intake and a variety of grains, green vegetables, legumes, and iron-rich food can help you maintain energy levels. Adequate fluid intake can prevent dehydration and low blood pressure, which can intensify fatigue symptoms. Regular exercise may improve appetite and increase nutritional intake
- Change in Activity and Rest Patterns: Using a diary to assess fatigue may help identify specific activities that increase it. Patients should record changes in energy levels. This information can help modify, schedule, or pace activities throughout the day to maximize energy. Maintain good basic sleep patterns, including a specific bedtime and wake time, reduced noise and light, and diversion activities, such as music and massage. Avoid stimulants (e.g., caffeine, nicotine, steroids and methylphenidate) and central nervous system depressants (e.g., alcohol) prior to sleep. Consistent exercise tends to improve sleep and can promote deeper sleep; it should be done at least six hours before bed time.
PALLIATIVE CARE – Purposes, Dimension, Types, Causes, Management