NEW YORK CITYIntegrating palliative care early in the course of cancer
treatment may permit patients to tolerate their treatments better and have a
better quality of life, according to Rose Anne Indelicato, ANP, OCN. A nurse
practitioner, Department of Pain Management and Palliative Care, at Beth
Israel Medical Center in New York City, Ms. Indelicato described the
multifaceted roles of department’s advanced practice nurses (APNs). In
addition to education and research, APNs are responsible for direct patient
care, much of it over the telephone. Their patients received assessment of
pain and symptom management earlier in their disease which may promote
longer survival, Ms. Indelicato noted.
Integrating palliative care early also abolishes the dramatic and often
emotionally difficult shift when active treatment ends and patients move to
hospice. Furthermore, early introduction of palliative care would benefit
the many patients that never get to receive the benefits of hospice because
of inaccurate predictions of survival and late referrals to hospice.
Continuity of Care
Although palliative care can add significantly to the physical,
psychological and spiritual well-being of cancer patients and their
caregivers, palliation of symptoms and aggressive treatment of underlying
disease appear to many people to be separate, and often opposed, categories
of care, Ms. Indelicato said. In current practice, palliative care often
begins only when active treatment fails. But palliative care can contribute
to patients’ welfare at every stage of the disease, she noted, and APNs
can have a crucial role in integrating palliation across the entire spectrum
of cancer care.
Early palliative care is an "addition, not subtraction" to a
treatment regimen, providing needed continuity among various phases of the
patient’s experience, she said.
Many providers, however, mistakenly view palliation as representing
"suboptimal" care. Practitioners often have limited expertise in
pain and symptom management and feel uncomfortable discussing such issues as
advance directives, she said. The experience of the APNs, however,
demonstrates that a focus on quality of life throughout the disease allows
for more continuity, better integration of religious and cultural beliefs
and superior pain and symptom management, she concluded.