What is palliative care and how does it differ from hospice care?

What is palliative care and how does it differ from hospice care?

So palliative care on average, right, all our treatment is palliative because at the moment we're not curing the vast majority of myeloma patients. But palliative care is thought to really be focused primarily on symptoms away from treatment for the actual myeloma. And we should be talking about symptoms at every visit. We should be talking about their GI function, their pain. We should be talking about avoidance of future symptoms such as fractures, things associated with anemia, kidney failure. These should be part of each and every visit in myeloma.

And so there's no bad time to talk about making quality of life better. Palliative care is a fantastic service. People tend to confuse it with hospice care. It's for people with serious illness that are also struggling with symptoms related to that illness. And symptoms can be anything from pain, insomnia, depression, fatigue, spiritual issues. Why does this happen to me? Sort of. That existential stuff in palliative care is delivered by a team of providers. So there's usually a physician, a nurse practitioner, a chaplain, and a social worker who are attending to the needs of the whole patient.

So not just looking at the patient through the lens of their cancer diagnosis, but looking at the whole needs of the patient and how their disease and the associated symptoms with that disease and the treatment that we are using to treat that illness are affecting the patient's ability to have quality of life. And quality of life means a lot of things to a lot of people. We all define that in a different way, and the type of care team really tries to get at that individual definition of what makes life worth living for you. And then they try to make sure that you can do that comfortably and safely as you can.

It differs a little bit from hospice care. I mean, certainly palliative care is part of hospice care, but you can get palliative care at any point during the course of your diagnosis and your treatment versus hospice care, which is really for folks who their healthcare team feels like the disease will likely result in their death within six months or so. And so this is really focused at end of life care. And again, palliative care is part of that managing symptoms. But hospice care is also very similar to care. And that it's delivered by this great team of professionals who are really trying to kind of envelope the patient and their family in care.

The main difference is with hospice, it tends to be at the end of life, but with palliative care, it's at any point during the disease trajectory. There's been a great influx into the number of palliative care providers all over the country in the last 10 to 15 years. And again, I mentioned the Commission on Cancer Accreditation. And one another part of that accreditation is that palliative care services are available either on site or by referral to patients.

And that each cancer organization has a method or a plan in place to link patients to guide of care services if they desire. One of my favorite patients and all my patients I'm very fond of. But I felt particularly troubled by this patient who had Velcade for three months, and at the third month showed up to infusion visit in a wheelchair. He couldn't walk. He could not feel anything below his thighs. We asked him at each time he got an injection and at each clinic visit, did he have any tingling, numbness or his hands and feet? And he denied it for three months until finally he couldn't take it anymore and said, I can't walk. I have a problem, but kept it quiet. We could have avoided his significant painful neuropathy had he just told us, hey, this is going on, you should switch me. You should use a different dose, a different method of administration. We could have made more difference.

So any way we could improve symptoms and have them patients communicate what's wrong? We can make life better and try to change therapy. Having a palliative care team member on your medical team is really important. And you can actually consult them at any point for different types of side effects related to the chemotherapy or the therapies. And this can range anywhere from sleep, fatigue, as well as eating and pain as well.

So having a palliative care specialist is not something that you necessarily need at the end of life. You know, oftentimes we will think about it in those manners. But they are good to have at any point during your care. And they can really help with side effects that sometimes maybe your general oncologist can't necessarily address.

Finding a palliative care doctor is dependent on where you are getting your treatment. So I would suggest that the first thing that you want to do is go to your treating oncologist and really ask them whether or not they have a specialist that they closely work with, to sort of address the needs of, you know, your specific case.

So starting out with just your general oncologist and going from there would be the best bet to try to find a palliative care specialist.