Published in Oncology and Expert Opinion / Commentary · December 19, 2022
Written by Lillie D. Shockney RN, BS, MAS, HON-ONN-CG
"Palliative care intervention provides meaningful benefit in end-of-life care planning for patients with metastatic breast cancer.
We are long overdue in involving palliative care specialists in the multidisciplinary team caring for patients with metastatic breast cancer. There were several reasons for this: 1) very often, an option for palliative care is not offered to patients until the treating medical oncologist decides on transitioning the patient to hospice care because she is too ill to continue with the treatment; 2) palliative care is assumed to be only available as a part of hospice care; 3) medical oncologists avoid engaging palliative care doctors in their treatment strategy because they feel they should be able to manage the patient's "pain," whereas palliative care is not just for pain, but also for managing overall symptoms; and 4) the term "palliative care" may have a negative connotation to it; therefore, it should be changed to what it really stands for––quality of life preservation or quality of life restoration.
Numerous studies have demonstrated results similar to those of this study and have even gone a few steps further in demonstrating an improvement in the quality of life, a reduction in anxiety, a better sense of control, and support for the emotional well-being of the patients and their family members.
Palliative care should be introduced before it is even needed in order that the patient is aware of a specialist who would be comfortable talking to her about what lies ahead, who would be able to control her symptoms and side effects without using opioids, and who would be an excellent listener so that the patient would feel comfortable expressing her genuine concerns. We owe it to our patients to provide this service early on.
At the Johns Hopkins Metastatic Breast Cancer Retreats I conducted semi-annually since 2006, one question that was candidly discussed is this: "Of everything that may lie ahead, what is your greatest fear?" This question was posed to the patients in one room and to their accompanying loved ones (usually a spouse/partner or female caregiver) in another room. The first response from the patients was always the same, “fear of pain and suffering and no way to get help for it.” In the other room, the loved ones' response was this: “Watching her in pain and suffering and having no way to fix it for her.” This promptly launched me into a discussion about palliative care. The patients always said “I don’t want to think about hospice yet.” They are routinely stunned to learn that palliative care can stand on its own and should already be part of the care they are receiving. Some institutions have changed the name to “supportive care” owing to the negative connotation palliative care has. What it really is about is preserving the patient's quality of life or restoring it. Let’s make sure that every patient has a palliative care specialist on her team even before she needs that expert help."
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