Abstract
Although palliative care is an established medical speciality, its contribution to the care of patients is still limited. We know that Lung cancer, until recently the leading cause of death from cancer worldwide (1), is a debilitating disease that results in a high symptom burden and poor quality of life (2) and has one of the lowest survival outcomes of any cancer (3). The effect of lung cancer on quality of life is progressive and dramatic, affecting all aspects of daily living for both patients and family members. However even for many lung cancer patients they are not referred to palliative care services until very late in the course of their illness, if at all, and many distressing symptoms are inadequately palliated. This lack of attention to symptom control in lung cancer is all the more pertinent when the recent paper by Temel (4) suggested that patients referred early for palliative care had better survival and outcomes
We need to remind ourselves as professionals of the aims of palliative care;
“Palliative care is the active holistic care of patients with advanced progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with other treatments”
Palliative care is of course not only applicable to patients with lung cancer but also to patients with other chronic lung conditions e.g. COPD, fibrosis etc. The involvement of a multidisciplinary team which works together focussing on the patient and addressing all symptoms which include the not only the physical but also the psychological, social and spiritual sequelae of lung diseases can and does impact positively on a patient’s quality of life (5,6). Professionals often fear that by mentioning the words “Palliative or Supportive” they may allow their patients to feel they have given up on them or that there are no further treatment options available. This is not true - the most effective palliative care works in synchrony with more active therapeutic options but hopefully also tries to prevent the frequent and multiple hospital admissions that many patients with chronic lung disease experience.
In the first of this series of papers Dr Jackie Ellis Research Fellow in Academic Palliative and Supportive Care at the University of Liverpool reports on the current research on the impact of lung cancer on patients and carers and also reports recent research carried out exploring most effective methods of physical symptom control and the crucial role that informal carers have in the effective delivery of palliative care interventions.