Symptom managers: The critical role of palliative medicine

December 7, 2018 | by Dory Benford

Purvi Patel, M.D. - Profile Photo Purvi Patel, M.D.
Over 38 percent of Americans will be diagnosed with cancer at some point in their lives, and this year alone, approximately 609,640 are expected to die from the disease. Despite these statistics, much of the general public is unaware of the services palliative care physicians can provide to terminally and chronically ill patients. We spoke to Purvi Patel, M.D., assistant clinical professor, Division of Palliative Care Medicine, Department of Supportive Care Medicine, about the role of palliative medicine in cancer care.

Palliative care can assist with symptom management

Palliative medicine isn’t exclusive to end-of-life care — it can actually be implemented much earlier in a patient’s cancer journey. Palliative care physicians can, for example, help keep patients experiencing harsh symptoms more comfortable.
Here at City of Hope, our titles say ‘supportive care’ for a reason. We are here to support patients at whatever stage they need it. Studies have even shown that when palliative care is involved, patients live longer,” Patel explained.
“We work a lot with symptom management. We are able to titrate and adjust medications to provide comfort. Oncologists don’t always work with the heavy doses of pain medications like we do, so they’re not always comfortable with that aspect of treatment. We can help with that.”

Patients can request palliative care support

Primary care teams often request palliative care services toward the end of life, but patients can also ask for help from palliative care specialists at any point in their cancer journey.
“We are a consulting service, so we have to be asked to help by the care team or the patient. I’ve had patients research palliative care and have their oncologists request our support,” Patel said.

Palliative care physicians are experts in end-of-life care

As terminally ill patients move closer to death, palliative care specialists can help alleviate some of the pain patients may be experiencing. They can help patients have hard conversations about their medical treatments and options moving forward with their families and care teams. They can also help soothe symptoms as they become more aggressive.
“We often see the sickest of the sick. Once we are called, usually things are pretty bad at that point,” Patel said. “Oncologists and hematologists are naturally very skilled at having tough end-of-life conversations; it’s the nature of what they do every day. But we are here to provide additional support, especially if the transition to end-of-life care seems like it’s going to be particularly difficult.”

Palliative care physicians improve patients’ quality of life

Palliative care is a patient-centered discipline that seeks to improve the patient’s life, not just physically, but mentally and emotionally. Having this type of support can help patients retain their dignity while facing debilitating diagnoses.
In palliative care medicine, we work with patients who have chronic, debilitating or life-limiting illnesses. The goal is to work with that patient and family to improve quality of life. So if you think about it, every patient who walks into a cancer center is deserving of a palliative care consult,” Patel said.

Palliative care physicians can act as an intermediary between patients and their care team

Patients can sometimes have trouble articulating their needs during an illness. Terminal and chronic diagnoses are complex, both emotionally and physically, and palliative care doctors are trained to handle these complexities and advocate for their patients.
“Every patient is different. Some people will say they’d rather live three months less and have better days than live three months longer and be in the hospital undergoing treatment every single day,” Patel explained.
“Sometimes, patients are even scared to talk to their oncologist or hematologist. I’ve had patients tell me they feel like they’re failing their doctor because they don’t want to do chemo anymore. Our job is not to undo what the primary team has done, it’s really to find out what the patient wants.”
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