Palliative care and hospice care are easy to confuse. Both seek to ease suffering in patients with chronic, life-threatening illnesses. However, with hospice, treatment aimed at curing the disease has ceased. Hospice care is meant for dying patients in their final months.
In contrast, patients can receive palliative care at any time — even during aggressive treatments such as chemotherapy and surgery. Often based in hospitals, palliative specialists help patients manage symptoms, sort out social and practical issues and find relief for spiritual suffering and emotional distress throughout the course of the illness and, hopefully, recovery.
Pain Relief
Brenda Overstreet, 39, of Cincinnati has faced cancer twice in the past two years. First it was cervical cancer and a hysterectomy. Then, seven months ago, extreme pain led to a CT scan that revealed a large mass on her liver.
Overstreet had six months of chemotherapy to shrink her tumor. Now she’s recovering from recent surgery, which she says removed more than half of her liver and “just a little bit” of one lung.
She’s been treated at the UC Barrett Cancer Center, part of the University of Cincinnati Medical Center. “It’s been quite a rough ordeal,” she says, but adds that the palliative team was “great,” including Elizabeth Rabkin, her palliative care doctor. “Through it all, she did everything she could to ease my pain,” Overstreet says. “I was in so much pain. You can’t really get rid of it, but she got me to the point where I could deal with it.”
Pain management is a big part of palliative care, says Georgia Anderson, manager of palliative care and outpatient social work within the UC Medical Center. Palliative teams closely monitor how patients respond to pain medicine and whether it’s working well enough. They may suggest longer-acting narcotics or different drug combinations to prevent flare-ups.
Managing Symptoms
Palliative specialists include physicians, nurse practitioners, social workers and chaplains.
“The word palliate means ‘to remove suffering,'” Anderson says, in whatever form it takes. For instance, the team may suggest a fan for a patient who’s having air hunger. The circulating air makes people at least feel like it’s easier to breathe.
As a cancer outpatient on chemo, Overstreet dealt with a lot of symptoms. “Several times over the weekend I’ve gotten very sick, with vomiting and everything, and I’ve never had a problem reaching somebody,” she says. But she’s even more struck by the personal side of her care. “Dr. Rabkin made me feel like a person, not just another patient,” she says. “Every appointment she seems to really connect. Not just ‘How’s your treatment going?’ but ‘How’s your life going?'”
Cancer patients, heart failure patients, those with neurological conditions, Lou Gehrig’s disease or any “serious and progressive illness that disrupts the quality in their life” can turn to palliative care, says Jane Sidwell, a palliative care nurse on the national board of directors of the Hospice and Palliative Nurses Foundation.
Where Palliative and Hospice Meet
Palliative care isn’t always end-of-life care — but sometimes it is.
“Hospice is a Medicare benefit for persons who are terminally ill and it’s expected that their lives will end within a six-month period of time,” Sidwell says. “Every single bit of hospice care is palliative care — it’s focused on relief of symptoms.” But not all palliative care is hospice, she adds, and “it can be provided much earlier in the trajectory of serious illness.”
Patients can be dismayed when offered palliative/hospice services. But more often, Sidwell says, the reaction is one of “incredible relief.”
“So we walk in the room and start with what the patient understands,” she says. “And you know, nine times out of 10 the patient says to you, ‘I don’t think I’m getting better. I don’t think I’m going to get better.'”
Now, Sidwell says, the conversation becomes: “The hope is you can feel better. We’re going to work on the pain; we’re going to work on the shortness of breath. We’re going to work on getting you home if you want.”
In September, the influential Institute of Medicine found that “palliative care is associated with a higher quality of life, including better understanding and communication, access to home care, emotional and spiritual support, well-being and dignity, care at time of death and lighter symptom burden.”
In addition, the IOM report says, “Some evidence suggests that, on average, palliative care and hospice patients may live longer than similarly ill patients who do not receive such care.”
What Patients Want
Sidwell recalls a patient who wanted her companion dog of many years to be at her bedside. “And we got the dog there,” she says.
Anderson says a patient’s goal might be to slow their cancer down enough to attend a family member’s wedding five months away, “but their treatment makes them feel terrible.” The palliative team could work with the oncologist to come up with a tolerable treatment plan.
Not long ago, Overstreet was struggling to pay her bills. “Going through all the treatment, I of course could not work,” she says. “There was a time when I was actually homeless, having to stay with relatives here and there.” Now she has her own place to stay, and she says social workers “have been absolutely wonderful” in helping her find housing and applying for disability benefits.
Overstreet feels like she’s turning a corner as she continues to heal, and she hopes to go back to work in a few months and remain cancer free. “At this point,” she says, “I’m doing very well.”
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Palliative Care: It’s About Easing Suffering originally appeared on usnews.com
