Recently several Pals attended the PMP/Appendix Cancer symposium at the University of California at San Diego, where Eric Roeland, M. D. spoke on palliative care during cancer treatment. He stressed that under the new model, palliative care starts early. Under the old obsolete model, palliative care normally would start after it appeared that other treatment was not moving the patient towards a cure. Your medical team now can set up a plan of palliative care very early to help both patients and caregivers deal with the physical and emotional side effects of cancer treatments. The goal is to improve your quality of life. We encourage you to take advantage of drugs, nutrition, exercise, emotional support, insurance or financial counseling, and other palliative care services to enjoy the best possible quality of life. Find out more about palliative care basics from the National Cancer Institute, http://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet.
Dr. Roeland gave an informative overview of the use of pain medication, common in palliative care. For example, did you know that for orally-administered pain medications, peak relief is reached in one hour? For IV-administered medication, it is ten minutes; for intramuscular, it is about 30 minutes. Please talk to your doctor about whether your pain is short term or long term, because that will affect what delivery system is used for relief.
He also addressed a common side effect of pain medication – constipation. For example, he contrasted the effect of stimulant laxatives to stool softeners. Motility is the issue when opioids are used – they slow bowel motility. A stimulant addresses that, a stool softener does not. He recommended a senna-based laxative. Patient response differs – some patients can take as little as one pill a day, others need up to 8. He recommended a senna tea for those particularly sensitive. If you are experiencing anemia, ask your doctor about an IV infusion to avoid constipation that oral iron supplements can cause. And, importantly, if you are experiencing sudden nausea or vomiting, it can signal a bowel obstruction, so seek emergency medical attention.
On the issue of loss of appetite, Dr. Roeland sees conflict at times between the patient who does not feel like eating and a caregiver who commonly expresses concern by providing food. Caregivers, if you find yourself in this situation, think of other ways to show your love so that food does not become a battleground.
Finally, remember that palliative care is not the same as hospice care, which normally is provided during the last few months of life. Palliative care can be provided whether the patient is undergoing a curative treatment or not. It should start early, and it seeks to ease side effects – both the physical and the emotional stress of cancer treatment. Early palliative care can result in a better quality of life for both patients and caregivers. Talk to your doctor about a plan for you.