The importance of symptom management: Palliative care at City of Hope

August 24, 2018 | by Kevin Chesley

Palliative care is focused treatment for the seriously ill, relieving patients from pain and stress. Many confuse it with hospice care, but Stefanie Mooney, M.D., assistant clinical professor in the Department of Supportive Care Medicine at City of Hope, explains how providers and caregivers can make the most of their patients’ quality of life by managing cancer symptoms, whatever their stage.

The Difference Between Palliative and Hospice

Palliative care is not the same as end-of-life care, Mooney explained. “Very commonly, patients and families are intimidated by palliative physicians because they think we’re the same as hospice, which focuses on the last six months or so of a patient’s life,” she said. “Instead, we focus on symptom management — things like pain, shortness of breath, nausea and the emotional impact of serious illness. Our methods are designed for any patient at any cancer stage.”

Palliative Care’s Many Faces

Still, Mooney said that “the majority of our patients are suffering from very advanced cancers. This results in complications ranging from constipation to nausea and pain, both from the cancer and the effects of the treatments. We help manage these symptoms through the use of medications and advice ranging from things they can eat to different exercises that may be helpful.”
 
Beyond medical interventions, other palliative care includes psychological counseling and spiritual care to alleviate depression, stress and anxiety. “Often a symptom on the physical side doesn’t exist without a symptom on the emotional side as well,” Mooney said. “Depression impacts how a patient manages their physical symptoms. It’s important to assess emotional impact, both for the patient and their family. The disease impacts the way they view themselves and their role in life.”

A Group and Family Effort

“We work very closely with the Department of Supportive Care Medicine, including our psychiatrists, psychologists and social workers,” Mooney said.
 
Every patient, however, comes with her own set of beliefs and values. “We really look at the big picture, what matters most in a person’s life,” Mooney added. “Many cultures make decisions about an individual’s care as a family unit, so we discuss goals and help the entire family understand what’s going on. We seek out every patient’s values and help them get along with their caregivers so they can work together as a team.”

Mid-Treatment Palliative Options

A final misconception is that palliative care comes after cancer treatment ends. “Many of our patients are receiving treatments for their cancer that come with side effects,” Mooney said. “The treatments in and of themselves are extremely important to prolong a patient’s life and help with symptoms. Many believe that you have to wait until curative options for cancer are complete, but palliative care actually helps manage the symptoms so that our patients can complete the treatments — and our help is also available on an outpatient basis for as long as those symptoms occur. We can help guide patients from diagnosis through their treatment and hopefully to recovery and survivorship as well.”
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