Palliative care
Despite advancements in treatment options, the progression of the primary tumor or widespread metastases still are a major cause of death. Therefore, the management of incurable disease should be given as much effort as the preceding attempts for a cure.
Doctors should not lose sight that the purpose of treatment is to ensure the best quality of life, even sometimes at the expense of the duration.
The common symptoms requiring palliation are pain relief, loss of appetite/ weight loss, dysphagia/ painful swallowing, nausea and vomiting, breathlessness, constipation, hallucinations and impaired breathing. The treatment of these symptoms should be used in ways that achieve the optimum therapeutic effect for the patient, even if there are potential long term adverse effects. For example, addiction to opioids is irrelevant for those patients who would otherwise die in pain.
Palliative care should be offered in discussion and with involvement from the patient and their family/ caregivers. To begin with, the prognosis and most likely sequence of terminal events should be assessed by the doctor. This should then be discussed with the patient and their close relatives, without stating precise predictions of survival times or terminal events to prevent distress.
The practitioner must highlight their commitment to maintaining quality of life and the relief of pain and distress for their patient and continually review palliative care provided in order to minimize side effects and mitigate problems building up. It is imperative that contingency plans are put in place and future nursing requirements are explored.