Palliative Cancer Care: 'The Glass Is Half Full'
While there have been advancements in palliative care programs and clinician education, more still needs to be done, one expert says.
Over the last decade, research has shown that palliative care can improve outcomes for patients with cancer, while providing relief from treatment-related symptoms. However, clinician training and the development of palliative care programs is still lagging in cancer centers across the nation, according to a study published in Cancer.
“Patients are living longer with better therapeutics, so there are a lot of people who are doing pretty well, but they have a lot of distress and side effects from treatment,” said study author David Hui MD, MSc, associate professor in the department of palliative care and rehabilitation at The University of Texas MD Anderson Cancer Center.
Hui and his team analyzed palliative care educational programs – such as research and fellowships – for health care providers at 52 National Cancer Institute (NCI)-designated cancer centers and 27 non–NCI-designated cancer centers between the years of 2009 and 2018.
Findings showed that NCI-designated cancer centers, on average, had more fellowships and research dedicated solely to palliative care.
“Education is critical. … The next generation of palliative care team members, physicians, nurses, chaplains, pharmacists, support the patient in a comprehensive way. And we need more researchers to feed that research loop that can provide knowledge and support their education. It’s all interconnected,” Hui said. “Regardless of which [setting] we are in, whether you’re practicing clinically or [conducting] education and research, we can push the field forward. We all need to do something, because there’s clearly a huge need for this form of care.”
However, the development of palliative care programs for clinicians and patients alike was slow at best.
“The take home message, I think is that the glass is half full and half empty,” Hui said. “There has been some progress, but in my mind, I feel that it’s still inadequate, and much more needs to be done.”
Hui acknowledged limited resources and funding as a major contributor behind the slow uptake of palliative care programs.
“Fundraising is still very much focused on cure more so than care, perhaps. I recognize that both of them are important,” Hui said. “In fact, I will argue that palliative care can hopefully help to improve the chances of patients getting through their cancer treatments (and) tolerate them better. So, they are truly hand in hand.”
By better educating patients and providers about palliative care and its benefits, Hui is hoping that more programs will be developed in cancer centers nationwide. However, the barrier of stigma still is prevalent – many people associate palliative care with end-of-life or hospice care. While it can be used in that setting, palliative care can improve the lives of people with any stage cancer or prognosis.
At MD Anderson, Hui said that the outpatient palliative care center had its name changed to supportive care.
“We found that actually helped to reduce the stigma from the perspective of the referral clinicians,” Hui said. “They feel much more comfortable talking about this term and getting patients involved, even though the program is the same.”
Hui explained that this type of care can be seen as preventative care in many ways. It provides symptom education early on, teaches patients how to use their medicine and avoid pain crisis and emergency room visits.
“Rather than preventing a fire, we are putting out a fire to begin with,” Hui said.
Hui D, De La Rosa A, Chen J, et. al. Palliative care education and research at US cancer centers: A national survey. Cancer. 2020. DOI: 10.1002/cncr.33474. Accessed March 25, 2021.