Palliative & end of life care
Palliative treatment is an important treatment modality as, for example, not all cancer will be curable. A tumour may be impossible to resect, there may be distant metastases present, somebody may not be fit for active treatment, there may be untreatable tumour recurrence, or somebody may decide to decline further aggressive treatment.
The aims of palliative treatment are to maintain quality of life as well as possible. Palliative treatment is not necessarily just a short-term treatment at the end of life (as many incurable conditions, with appropriate care and treatment, can be lived with for considerable periods of time) but will include end-of-life care. Palliative treatment aims to alleviate any suffering. Typically, this includes optimal pain control, as well as emotional, social and spiritual support.
These care needs (and expectations) will vary strongly from person to person, a personalized approach is therefore important. Palliative treatment of malignancies can be viewed as ‘active’ where an intervention, usually chemotherapy (in some cases up to six lines of chemotherapy are tried), immunotherapy, or very limited radiotherapy (for example, localised low-dose radiotherapy to spinal metastases to relieve both pain and spinal cord compression) are used, or as ‘best supportive care’ where no active intervention is used.
The approach is similar to treatment with curative intent, in being team based, with good communication between all involved. The concept of palliative care at the end of life is most commonly associated with the terminal stage of malignant diseases, at least in the context of oral and maxillofacial conditions. However, other common terminal conditions such as heart, kidney or liver failure, as well as various degenerative conditions, carry a similar disease and symptom burden toward the end of life. Hospital or hospice based expertise from palliative care teams, pain management teams and the caring environment of hospices can make an invaluable contribution to the quality of the end of somebody’s life.