Palliative Medicine for Serious Illness: Living Longer and Living Better
By Ira Mandel, MD, MPH, Palliative Medicine physician and medical director of Pen Bay Healthcare’s Hospice and Palliative Care program.
Roger was busy living his life when, without warning, he was diagnosed with lung cancer. In an instant, gone were his easy, comfortable routines peace of mind and future plans. Suddenly, his future was in doubt and he feared nothing would be ever the same again.
Overwhelmed with the devastating news, he dedicated himself to never giving up. He refused to hear anything except that he would be cured. But his physicians told him that the only thing they could offer was to try and slow the cancer down. They said they could not cure it.
He read everything he could get his hands on. There were many new drug trials and lots of information about “alternative medicine”. A skeptic by nature, Roger was willing to consider anything, but decided to seek only the most modern treatments American medicine had to give.
To his horror, his physician told him that further testing also showed cancer involvement of his liver and adrenal glands, even though he displayed no localized symptoms. He was beginning to feel very tired and weak, but had no real pain when he was first diagnosed. Though he had quit smoking, he became more short of breath and lost his hearty appetite.
No matter how hard Roger tried to put any thought out of his mind that he could not be cured, there were constant reminders that each passing day was moving him closer to his last.
To his astonishment, his physician mentioned that not everyone chooses to have aggressive treatment. Some people just “try to make the best of the time they have left” to focusion a better “quality of life”, adding this was a very personal decision. The physician also said that, often, cancer treatments may not be very effective and may cause the patient to feel sick from the treatments.
The physician shared some recent surprising news to Roger. In a study published in one of America’s most prestigious medical journals, research found that patients who received “Palliative Medicine” lived almost three months longer than patients who received standard lung cancer treatments alone, without Palliative Medicine.
Somehow, he had to come to terms with his cancer. Agreeing to anything that would extend his life and make him feel better, he asked what exactly Palliative Medicine was and “what did it do”?
His physician answered that he, like so many other physicians and patients, did not know much about Palliative Medicine in the past but was learning more all the time. From what he knew, it was best provided by a “team” of specially trained professionals including: specialized physicians, nurses, nursing assistants, social workers, counselors, chaplains and layman volunteers.
These expert teams treat both the physical and psychological symptoms and place a strong focus on helping patients spend their time as “meaningfully” as possible. The team spends a lot of their time listening to find what is most important to the patient and then helps to make those important things happen. Spending time with family and friends is often at the top of their list, particularly when relationships are in need of healing. Also, while some patients have their versions of the “bucket list”, many just want to celebrate family events, hold a pet and enjoy the comforts of home.
In fact, Palliative Medicine focuses most of its care in peoples’ homes. Many physician’s and nurse’s visits are old-fashioned house calls with an emphasis on letting people stay at home instead of having to visit the emergency department, stay in the hospital or move to a nursing home. In reality, Palliative Medicine is delivered wherever the patient is to ensure patients get the care they most want and value.
In the end, Roger agreed to give Palliative Medicine a try. He was pleased to receive the added attention from the palliative care team, found that he was less fatigued, ate better and laughed more. He knew no one could tell him how long he would have to live, or if Palliative Medicine would help him live longer, but he was very pleased to know that Palliative Medicine would make his days better. To some degree, that was all he needed to know.
Ira Mandel, M.D., MPH is a Palliative Medicine physician and is medical director of Pen Bay Healthcare’s Hospice and Palliative Care program. He provides compassionate care with a team of health professionals who honor the wishes of patients with serious illnesses. His monthly column seeks to inform the public about choices they may wish to consider. Disclaimer: All people described in this column are not actual patients but are derived from many hundreds of patients Dr. Mandel has treated over many years.