Palliative care refers to a specialty of medicine that aims to relieve pain and other signs and symptoms associated with a terminal illness. The term ‘palliative care’ is derived from the Greek word ‘palliation,’ which means ‘to tide over’ or ‘to ease’ a crisis or terminal illness. Palliative care focuses on addressing a range of an individual’s physical and psychological health concerns during advanced stages of cancer. This improves quality of life potentially increasing lifespan in some. In certain cases, the care is also extended to the family members who are unable to cope with the critical situation.
Urological cancers are common and include several types such as prostate cancer, bladder cancer, kidney cancer, testicular cancer, penile cancer, etc. However, few people are taking advantage of palliative care even though it can be of great benefit, says Dr Raghavendra Ramanjulu, lead consultant, palliative medicine & rehabilitation, Aster CMI, Bangalore.
Dr Sneha Rooh, a palliative physician and psychotherapist working in a private practice in Delhi shared her experiences, “Palliative care in urological cancers has direct indications, for example, in prostate cancers we find bone pain, lymphedema [swelling in an arm or leg caused by a lymphatic system blockage], urinary tract obstruction and other symptoms affecting individual’s quality of life.”
Palliative care for urological cancer helps manage symptoms better
“Many people diagnosed with urological cancers come to the hospital with acute problems like painful urination, obstructions or bone metastases that can lead to fractures and unbearable pain. The specialists take care of these acute concerns by providing immediate pain relief and palliative care,” says Dr Ravi Chandran K, Uro-oncology surgeon at Apollo Hospital, Bangalore.
Dr Chandran explains, “The goal of palliative care is to balance treatment effectiveness with individuals’ tolerance and response to the health condition; not overloading them with medications and treatments which might turn out to be more harmful.”
“A person diagnosed with prostate cancer having extensive bone metastases [when cancer cells spread to a bone from their original site], especially in a particular bone area such as the femur, can cause them intense pain. In these cases, palliative radiation treatment [high-energy X-rays to target cancer-affected cells] is provided to relieve the pain in these affected areas,” Dr Chandran adds.
Concerns associated with palliative care services
A study published in the Journal of Urologic Oncology: Seminars and Original Investigations in the year 2023 reveals that of 272 individuals with bladder cancer and their caregivers, only 9% of the respondents were aware of the process and how palliative care works. Others in their metastatic stage (when cancer spreads to a different part of your body from where it started) wish they knew more about the process and how it can be used as end-of-life care.
Explaining the concerns, Dr Rooh says that palliative care faces this challenge because there is a lack of awareness. Many medical professionals themselves need more understanding of palliative care and hence are very unlikely to refer.
She says, “There is a dearth of palliative care departments in most hospitals and often clubbed under anaesthesiology [a medical aspect of pain management] though palliation is more than that. Also, it is usually considered as end-of-life care, hence the diagnosed individuals as well as their families are not motivated enough to take the services.”
Moreover, she explains that people fear opioids, especially morphine and tramadol, as they think this will be life-threatening or they might get addicted which is untrue when the dosage is carefully handled by a skilful physician.
Multi-disciplinary approach of palliative care in cancer
Palliative care is usually a multi-disciplinary team-based approach to managing symptoms and concerns throughout the entire treatment journey.
Experts assert that palliative care is closely intertwined with pain management, wherein pain specialists provide medications. Some individuals with cancer may not be able to eat properly, which affects their quality of life significantly. Nutritionists or dieticians are often assigned to treat these individuals. Intensive treatment may limit mobility in the final stages of cancer, where physiotherapists are assigned to provide comfort and support to the individuals.
Psychological counseling is an integral component of palliative care, along with other interventions which can be particularly challenging for both the individual diagnosed and their immediate family. For people with urological cancer, issues such as the loss of control over urination or fecal leakage may evoke feelings of embarrassment. Onco-psychologists, who are clinical psychologists trained to handle critical situations, play a crucial role as members of palliative care teams.
Benefits of palliative care services
The benefits of palliative care include the treatment of immediate symptoms such as pain, bowel and bladder issues, emotional support, and the reassurance that those affected are not alone in their fight against cancer. This support system is important because it gives hope of being able to fight the condition better.
Once the physical and psychological challenges of a person diagnosed with cancer are taken care of, they often find acceptance which leads to a more comfortable journey for everyone involved.
Palliative care focuses on symptom management and also involves healing. Dr Ramanjulu says, “Palliative Care is about improving quality and quantity of life as far as possible. When symptoms improve, individuals can eat better, sleep better, and recover better. This naturally leads to better adherence to treatment.”
Takeaways
- Palliative care is currently not common in urological cancers and needs to be discussed by the specialists with the diagnosed individuals.
- In palliative care, a whole team of specialists including pain specialists, dieticians, physiotherapists, and onco-psychologists to name a few helps manage acute urological symptoms.
- Reaching out to the specialists with queries can help clarify the doubts associated with palliative care which is stopping the individuals diagnosed with cancer from taking the services.
