Palliative Care Enhances Quality of Life for Patients With Cancer

Michelle M. Issac, MD

Palliative medicine continues to be a vital part of oncology care. According to Michelle M. Issac, MD, palliative care exists to help prolong the lives of patients with advanced illnesses as well as improve their quality-of-life. The work of palliative care professionals in cancer involves close collaboration with oncologists.

In an interview with Targeted Oncology™, Issac, palliative care physician, Miami Cancer Institute, discussed the goals of both palliative care and oncology care professionals as they support patients with cancer.

TARGETED ONCOLOGY: Can you provide an overview of your recent presentation?

Issac: I talked about the role of palliative medicine and rehabilitation for patients. I share many of patients with our cancer rehab colleagues. It's not uncommon for patients to experience pain and other symptoms that we can help and assist with. The palliative care team treats pain and other symptoms related to the cancer diagnosis itself, vs the treatment. We also help with support and we help with communication. We know that patients see a lot of different teams and things can be overwhelming. We help facilitate and consolidate information. We also help patients achieve a goal to provide the best quality-of-life for them.

Hopefully, we're able to do that by helping them with their day-to-day tasks and help them be functional. Alongside the rehab physicians and teams, our goal is to help patients be as functional and be able to have as much normalcy as possible.

We help patients with making decisions to plan for the future. My presentation talked about a lot of what we do, and the role that we play, but also some of the differences and barriers that may prevent patients from seeing us or being hesitant to do that first appointment.

What advice do you have for oncologists on transferring patients to palliative care professionals?

Cancer is a very complicated diagnosed, and patients with cancer are multifaceted. They have their actual disease process, their social and family dynamics, and so, there's a large role that we can play in their cancer care. Times that oncologists can consider referring to us is if they're having a lot of symptomsand it's getting to a point where the first-line medications are no longer able to manage their symptoms, and it's really affecting the patient's day to day. With patients with life limiting illnesses, a lot of our patients have advanced cancers. This is also where we play a key role.We can help with advanced cancer, advanced care planning, filling out documentation, including a living will or health care surrogate Power of Attorney. That's where it will be important to refer to us.

Patients who have limited treatment options are having a lot of significant [adverse] effects from their treatments. These are patients that can benefit from seeing us. Something that's not thought about as much is when there's a lot of psychosocial distress between the patient and their families or different dynamics. Another thing is when the patient needs to be transitioned into hospice. This is something that we can help facilitate.

Can you explain the continued role of the oncology care team in palliative care?

Most of our patients are still followed by oncologists when they're referred to us. They are typically treated with anycombination of chemotherapy, radiation, immunotherapy, and so they're still closely followed by their oncologist, sometimes every 2 weeks or monthly depending on the treatments that they're receiving. They're either getting curative treatment, or non-curative treatment, which is also called palliative treatments. These palliative treatments are meant to prolong their life or improve their quality-of-life.

Oncologists play a key role in deciding which treatments patients should be on, what's most appropriate at this moment in time and managing complications and the treatments itself, as well as of the cancer. They also play an important role in complex decision making. We go hand in hand with making those decisions. We are in communication, especially when the situation is not clear cut, and we are in communication with the oncologist and their other providers to help the patient make the best decision for them.

What are the key goals for end-of-life care for a patient with cancer?

This is something that comes up a lot. In terms of end-of-life care, our goal is to always help provide comfort and symptom relief to patients, all the while providing support to them and their loved ones. This is going to be the most difficult time in a patient's life and for their families,and it's something that affects the whole family, and not just the person itself. They're all going through it together. We're there to provide the best quality-of-life and hopefully allow them to do the things that are most important to them.

Also, many patients are feeling fearful of what the end of their lives will look like. They might ask questions like; Will I be in pain? Will I have trouble breathing? So, these are things that we provide guidance and reassurance and are always available to them if they have these questions or are experiencing these symptoms. By being accessible, we hope that we can get ahead of some of these symptoms. But if we're not, we are just a call away in case they are experiencing pain that they can't control with the medications. We're always available to be able to add whatever medication is appropriate. Generally, we want to focus on maintaining the patient's dignity and respecting their values and morals and cultural beliefs. We always want to respect a patient's wishes and we hope that we're able to see them through and keep them as comfortable as possible.