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Palliative Care Unit

Sometimes, due to the progression of cancer, some active treatments must be suspended to initiate treatments aimed at relieving the symptoms suffered by patients and accompany them in the last months of life, while ensuring they still have an adequate quality of life.

 

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Even though, this type of support for patients and their families has been included within the field of palliative care, nowadays we believe that it takes on a much broader scope, which includes not only pain management, but also psychological and nutritional support and the maintenance of a reasonable degree of physical fitness. The focus is placed on patients, to make life as satisfactory as possible for them and with regard to their loved ones.

The management of pain and symptoms caused by tumour growth is probably one of the most common requests by patients with tumours which cannot be oncologically treated. A patient’s quality of life and their ability to enjoy social interactions can be greatly affected if they are in pain, experience haemorrhages or have limited movement. While opioid analgesics are often used, the delivery of palliative radiotherapy is essential when pain is caused by bone involvement or if the patient is experiencing tumour haemorrhages or difficulty walking due to spinal cord compression. These non-toxic treatments are administered in a very precise manner and often require only very few sessions (1-5), offering a fast, effective and safe relief of many of these symptoms.

 

Maintaining physical fitness: nutrition and exercise

 A lack of appetite and subsequent weight loss as cancer progresses is often a major cause of distress for many patients, and particularly for their relatives. This requires a major collaborative effort between the oncology nutrition team and the patient, with the help of the patient’s family members and loved ones.

The patient’s diet must be adjusted in accordance with their life expectancy, individual tastes and medical situation to prevent malnutrition as this can be frustrating for everyone. The quantity, timing and composition of meals must therefore be carefully monitored and guided by qualified professionals.

Some patients have limited mobility due to the disease itself or to the multiple oncological treatments carried out. Weight loss is also often accompanied by a lack of interest in even the lightest physical activity. Progressing cancer patients should be aware that maintaining a certain level of physical activity allows them to enjoy their family and their social interactions to a greater extent.

The benefits of moderate exercise are also significant from a psychological point of view. Recovery and maintenance exercise programmes must be guided by a professional team that includes rehabilitation doctors and physiotherapists, who will design the most appropriate protocol for each case.

 

Psychological support for patients and their family

The long struggle against the disease and the loss of a therapeutic target can make it even more difficult from a psychological point of view to cope with the situation that patients and their loved ones are facing. This situation calls for the strengthening of the support offered by oncological psychologists to create individualised strategies based on each specific case, mainly aimed at reducing anxiety and avoiding depression.

In addition, it may be necessary to seek the help of a psychiatrist to include medication as part of the treatment. In any case, it is very important for everyone (patients, family members and health professionals) to accept and face the situation they are going through in a gentle and clear manner to allow for a loving and honest discussion and to make the patient feel supported throughout the process. Some people may think that it is better not to talk about it or try to minimise the situation. This is known as “the conspiracy of silence”, a situation where everyone knows what is happening but no one talks about it and nobody is allowed to express their true feelings.

 

The care of the terminally ill patient

In their last weeks of life, patients may either require hospital admission or they may prefer to receive care at home with their loved ones.  Symptom control and psychological and spiritual support are the priorities at this time.

Cancer patients need complex and highly specialised multidisciplinary support when the disease progresses and no active cancer treatments can be prescribed.

Pain and symptom management using analgesics or palliative radiotherapy, together with nutritional and psychological support are the pillars on which individualised patient strategies are based to provide a prolonged quality of life for cancer patients.

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