From Curative Treatment to Palliative Care in Cancer Treatment

Dr Penny Schofield, the Pratt Foundation Senior Research Fellow at the Peter MacCallum Cancer Centre in Melbourne, has reviewed the evidence on how best to talk to people about making the transition from curative cancer treatment to palliative care.

She told the ABC Radio’s Health Report that there was community fear about the name palliative care, triggering fears of helplessness, abandonment by the medical profession and impending death. But palliative care services can be provided simultaneously with active treatment and curative treatment she said.

One trial has shown that the introduction of palliative care services improved family and patient satisfaction, reduced family anxiety, provided much better pain control and symptom management and also increased the likelihood that the patient was being cared for at the place of his or her choice.

She said that there was a hesitation about doing good quality research in this area because the participants in the research have got limited time left and are very vulnerable and often very ill people.
There needs to be a fairly good understanding of prognosis and the patient has to be prepared to have a discussion about prognosis and not all people are. But that can change over time. Once the doctor has actually reached to the point of being able to sensitively convey the information that no curative treatment exists for their disease, it might be appropriate at that point to introduce the topic of future treatment options.

At each step of the way the doctor should ask the patient whether or not they would like to discuss this next topic. There is an increasing view that the introduction of palliative care should not be a distinct event, but a gradual transition.

Dr Schofield said that research into people with inoperable lung cancer had shown that people’s beliefs about hope and their positive attitudes towards cancer made no difference to the outcome. However she thought that hope was critical for a person’s emotional well being, so while communicating this transition to palliative care it was critical that messages of appropriate and realistic hope were referred to throughout this communication process.