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Providing Palliative Care for the Newly Diagnosed Cancer Patient: Concepts and Resources

Providing Palliative Care for the Newly Diagnosed Cancer Patient: Concepts and Resources

ABSTRACT: Palliative care has evolved from end-of-life care following exhaustion of curative therapy to care across the cancer-management continuum. Often initiated concurrently with curative care at the time of diagnosis, palliative care ensures both effective symptom management and the best possible quality of life in four key domains—physical, psychological, social, and spiritual. The significant growth and development of palliative care in the United States is evident in that one in four hospitals now has a palliative care program, palliative medicine is now recognized as an official medical subspecialty by the American Board of Medical Specialties, and national programs offer comprehensive continuing education in palliative care for nurses and physicians. The oncology nurse who provides palliative care does so as part of a multidisciplinary team that includes not only physicians but also can involve chaplains, massage therapists, pharmacists, nutritionists, and other specialists. This article provides resources and reviews and highlights pertinent palliative care issues to guide oncology nurses managing newly diagnosed cancer patients.

The three words “You’ve got cancer” can change someone’s life. After being diagnosed with cancer, questions arise: Can it be cured? Why me? Am I going to die? Luckily, as advances have been made in the treatment of cancer, the diagnosis of cancer is not necessarily a terminal one. In fact, many cancers, such as breast or colon cancer, when detected early enough, are curable, and treatment advances have resulted in long-term survivorship across many cancers.

There are now more than 11 million cancer survivors in the United States. Regardless of the type of cancer or prognosis, there is a role for palliative care beginning at time of diagnosis.

Palliative care, also known as supportive care, is sometimes assumed to be care delivered solely for patients who are dying. The concepts of palliative care did arise from the hospice movement, but have expanded beyond the notion of care provided at end of life. Palliative care is defined by the World Health Organization as “an approach that improves the quality of life of patients and their families facing the problems 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.”[1]

The National Comprehensive Cancer Network (NCCN) defines palliative care in its clinical practice guideline for palliative care as “both a philosophy of care and an organized, highly structured system for delivering care to persons with life-threatening or debilitating illness. Palliative care is patient and family-centered care that focuses upon effective management of pain and other distressing symptoms, while incorporating psychosocial and spiritual care according to patient/family needs, values, beliefs, and culture(s). The goal is to prevent and relieve suffering and to support the best possible quality of life regardless of the stage of the disease or the need for other therapies. Palliative care can be delivered concurrently with life-prolonging care or as the main focus of care.”[2]

Historically, the transition to palliative care occurred after all curative therapies had been exhausted. Professionals in the field of palliative care have worked to shift this notion from palliative care beginning after curative care ends to palliative care delivered concurrently with curative care—in other words, palliative care initiated at time of diagnosis.

Much of the care that nurses provide, aside from administering oncologic therapies focused on cure, falls under the domain of palliative care. Treating nausea from chemotherapy or pain from mucositis, and educating patients on ways to minimize fatigue secondary to radiation or chemotherapy are all interventions to improve patients’ quality of life.

The purpose of this article is to review current resources that exist for nurses in the treatment of symptoms, as well as to highlight other issues that arise for the newly diagnosed patient that need to be addressed in order to reduce suffering and to treat the whole person.

Resources

Evidence-Based Interventions: ONS PEP Cards

Symptoms that are caused by cancer often diminish and resolve once treatment is started. However, most therapies come with side effects. Many resources and evidence-based guidelines have been created to help nurses in treating these distressing side effects. The Oncology Nursing Society (ONS) has published such a resource, entitled Putting Evidence into Practice (PEP) Resource Cards. The process of creating this resource is described by Gobel, Beck, and O’Leary.[3] Distributed by ONS, the topics addressed to date are listed in Table 1.

Table 1

These resource cards review the existing literature and organize the information/interventions into five sections: recommended for practice, likely to be effective, benefits balanced with harms, effectiveness not established, and expert opinion.

In addition to the portable cards, the ONS web site http://www.ons.org/outcomes/measures includes more detailed PEP cards that provide additional information regarding the research reviewed, evidence-based

summaries on each of the symptoms reviewed, and tables of evidence that include details on sample and setting characteristics, study design and conceptual model, measures, results and conclusions, limitations, and the ONS level of evidence and comments. The above topics are of special significance to the newly diagnosed patient undergoing treatment.

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