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The appearance of new treatments has meant many people with cancer can now be cured, or at least live a lot longer. This point, coupled with an ageing population, means there are increasingly more people with cancer in all stages of its progression.
Current estimates assert that 50% of cancer patients are cured, while the remaining 50% live longer. According to data from the Observatori del Pla Director d’Oncologia in Catalonia the chances of living for 5 years with an advanced cancer present an accumulated increase of 1% each year. This is a period in which patients must live with the disease, often with advanced cancer or with a high symptom burden.
Palliative care aims to improve the quality of life of patients with a serious or life-threatening disease, such as the case of cancer. The World Health Organisation (WHO) defines it as comprehensive care that addresses both the physical symptoms as well as the psychosocial, emotional, socioeconomic, family and spiritual impact on the patient. The aim is to reduce the symptoms, favour patient adjustment to persistent symptoms, assess their emotional response to the disease, coordinate the care provided by the various healthcare professionals and analyse how the situation is accepted in the social and family environment.
It is important to understand the life experience collectively because just as the patient suffers, so do their family.
Comprehensive palliative care is provided by a multidisciplinary team (doctors, nurses, social workers and psychologists) who care for the patient throughout a specific period of the disease process. Patients can receive palliative care in a hospital, in an outpatient clinic, in a long-term residential care facility or at home under the supervision of a doctor.
When is palliative care required?
It is important to realise that there is no separation between palliative and curative treatment, rather the two treatments should be implemented together (concurrently). In other words, one treatment does not exclude the other. There is evidence that an early palliative intervention not only improves the physical symptoms but also reduces the emotional impact, thus improving the curative treatment and expectations for survival. It is not a question of implementing a curative or palliative treatment, but rather they should each have a specific weight at different stages. When the disease is quieter, the curative treatment takes on more weight, whereas in more advanced stages the palliative treatment is more important, but they are not mutually exclusive.
When curative treatment is no longer the goal, palliative care acquires more prominence because at this stage it helps both the patients and their loved ones by:
preparing for the physical changes as they approach the final stages of life;
dealing with the range of thoughts and emotional problems; and
providing support for relatives.
The end-of-life process is a life experience that is individual and specific to each person and it is important that patients and their families never feel abandoned.