Palliative Care and Cancer

Palliative care is a specialty that is relatively new but that has evolved steadily over the past few decades. Its goal is providing advanced cancer patients with end of life care. Its rise was because of the public's growing dissatisfaction and concern with how dying patients were being taken care of in the 1960s and the 1970s (Cole, Carlin & Carlson, 2015). At the time, oncologists were mostly concerned with curative interventions and so did not give the necessary attention to end of life care.

According to the studies that were done at the time, medical care that was given to the terminally ill was suboptimal or in some cases did not even exist. The father of palliative care, Dave Cicely Saunders, reported having the same experience. She was the founder of St. Christopher's Hospice, based in the United Kingdom. The facility was the first modern hospice (Cole, Carlin & Carlson, 2015). The founding of the hospice was a definitive moment that would shape palliative care all over the world (alMahrezi & AlMandhari, 2016).

There has been tremendous growth of palliative medicine as pertains to needs, concepts and acknowledgement. Discussions about end of life and palliative care have been very productive since the dawn of the millennium (Cole, Carlin & Carlson, 2015). There has been 138% increase in palliative care team in healthcare settings in the new millennium. The specialty has grown tremendously and providers have increasingly embraced it as people with better training and apprentices emerge to provide palliative care.

Nonetheless, access to palliative care is still limited due to inequity in distribution of care with most of the facilities being concentrated in richer areas. Those not suffering from cancer still have limited access to palliative care. Globally, over 20 million people, 6% who are children and 78% people in low to middle income nations, need palliative care. Just 10% of the need for palliative care is being met (alMahrezi & alMandhari,2006).

The new definition from WHO, unlike the old one, emphasizes the need to provide palliative care early in the life cycle of an illness and not waiting till the later stages. This informed by the need to support patients with chronic diseases that have high symptom burden and so help relieve the weight of the burden on the families.

Almost similar to the WHO definition are the definitions given by the National Cancer Institute (NCI) and the American Cancer Society (ACS) which primarily focus on the caregiver and the patient instead of the disease. NCI's definition goes further to include symptomatic relief the earliest possible and suggests treatment of symptoms resulting from therapeutic measures (AlMahrezi & AlMandari, 2016).

Patient Referral for Palliative Care Along the course of the disease advancing and the treatment plan, family members and patients get confronted with hardship situations such as great physical distress, unanswered spiritual concerns and poor coping behavior and these challenges can greatly reduce the quality of life of those affected. The approach taken by palliative care takes these issues into consideration and addresses them. Also, the exercise ensures that the transition to hospice care from hospital care is smooth.

Studies done in various jurisdictions across the world reveal that patients receiving palliative care intervention plus oncology treatment tend to record a higher quality of life than their counterparts who only receive oncology care (Devi, 2011). Dealing with the symptoms of a life-limiting condition can be a challenge for any healthcare workers. Palliative care avails a solution and plays a key role in managing situations where the life of a patient is seriously limited, and may become even more unbearable with distressing symptoms and massive pain (Devi, 2011).

Where a patient has cancer, despite the great progress that has been made in research and therapy, the patient still has to deal with several problems and issues such as intolerable symptoms and uncertainty in prognosis, which may in turn lead to development of disabilities, anxiety, depression and low self-confidence. When such a situation arises, the quality of life of the patient is greatly reduced and palliative care can offer refuge and help the patient regain their confidence and psychological wellbeing (Devi, 2011).

Palliative care not only gives the patient emotional support, but also helps the family to cope and open up to discussing the issues surrounding the disease such as its management and treatment options. When more people become more accepting of palliative care, referrals start coming in relatively earlier than is the case right now. Most of the referrals being done occur late in the lifecycle of the illness and averages around 1 to 2 months before death (Bruera & Hui, 2010).

Role of APNs in Palliative Care Palliative care can be viewed as a fundamental right. It ensures care is given throughout the spectrum of an illness and is available globally though it is concentrated more in the West. It is an approach to care that involves several disciplines and that has strived to achieve a level of uniformity in drugs used and their pricing.

Going into the future, more political and professional support as well as public-private partnerships are needed to tackle the problems that the sector faces, and increase its acceptance and use in the society. Further, there is need for medical education to cover palliative care and for it to be integrated in the societal framework as well as in the healthcare system (Bhatnagar & Gupta, 2015). The role APNs play in palliative care is increasingly being recognized in the U.S.

The ability of APNs to carry out comprehensive physical evaluations, interpret diagnostics, and make prescriptions makes them very valuable to patients in any healthcare setting (Kuebler, n.d.). APNs have consistently demonstrated that rural populations, cultural diverse communities, nursing homes and the frail and poor make up demographics that are not adequately served with palliative care. APNs can help break into these communities and bridge the gap in access to palliative care.