Beginning Palliative Care Early May Allow Patients to Better Tolerate Treatment

NEW YORK CITY—Integrating palliative care early in the course of cancer treatment may permit patients to tolerate their treatments better and have a better quality of life, according to Rose Anne Indelicato, ANP, OCN. A nurse practitioner, Department of Pain Management and Palliative Care, at Beth Israel Medical Center in New York City, Ms. Indelicato described the multifaceted roles of department’s advanced practice nurses (APNs). In addition to education and research, APNs are responsible for direct patient care, much of it over the telephone. Their patients received assessment of pain and symptom management earlier in their disease which may promote longer survival, Ms. Indelicato noted.

Integrating palliative care early also abolishes the dramatic and often emotionally difficult shift when active treatment ends and patients move to hospice. Furthermore, early introduction of palliative care would benefit the many patients that never get to receive the benefits of hospice because of inaccurate predictions of survival and late referrals to hospice.

Continuity of Care

Although palliative care can add significantly to the physical, psychological and spiritual well-being of cancer patients and their caregivers, palliation of symptoms and aggressive treatment of underlying disease appear to many people to be separate, and often opposed, categories of care, Ms. Indelicato said. In current practice, palliative care often begins only when active treatment fails. But palliative care can contribute to patients’ welfare at every stage of the disease, she noted, and APNs can have a crucial role in integrating palliation across the entire spectrum of cancer care.

Early palliative care is an "addition, not subtraction" to a treatment regimen, providing needed continuity among various phases of the patient’s experience, she said.

Many providers, however, mistakenly view palliation as representing "suboptimal" care. Practitioners often have limited expertise in pain and symptom management and feel uncomfortable discussing such issues as advance directives, she said. The experience of the APNs, however, demonstrates that a focus on quality of life throughout the disease allows for more continuity, better integration of religious and cultural beliefs and superior pain and symptom management, she concluded.