The concept of palliative care has been evolving over the last 25-30 years, really starting with Dame Cecily Saunders back in the 1960s.
As the success of modern medicine has evolved people are living for much longer with cancers, the symptoms that come with treatment and the symptoms that come with survival.
Many patients are experiencing a lot of different treatments, a lot of different symptoms during those treatments and really the need for palliative care has grown immensely.
While it started out with care at the end of life and care and support for families who lost a loved one, what we call bereavement support, today we have real evidence that early palliative cancer care can really benefit patients, the families and can actually make life easier, even for the treating medical teams as well as the healthcare systems.
A lovely study published by Jennifer Temel which was a randomised controlled trial of non-small cell lung cancer where some patients got standard treatment, other patients got standard treatment plus three months of early palliative care demonstrated both a survival advantage as well as improved quality of life for those patients and their families.
As a result of not only that study but others, and really our experience with treatments like the management of congestive heart failure where the real goal is to keep patients comfortable, manage their breathlessness, their fatigue and keep them as functional as possible, we really see that in fact aggressive palliative care provided early in cancer or other diagnoses can not only improve people’s quality of life but can actually help them live longer.
We’ve also got some evidence, a paper from Dr Margaret Caplan looking retrospectively at the costs of providing care in the last two years of life in the United States within the Medicare dataset, actually showed a financial advantage as well where the cost of care in the last two years of life where there’s really much more aggressive integration of palliative care in San Diego county, where I was working, where many of the physicians have training in palliative care skills, actually two-thirds the costs compared to Los Angeles county.
Now that’s a retrospective study and we need more data to actually further demonstrate both the efficacy, survival advantage, as well as the cost-effectiveness but there are many reasons to advocate.
Simply put, if we can help patients eat better, maintain their function, minimise their stress, don’t we imagine they’re going to do better with their therapies and live longer.
And organisations like the American Society of Clinical Oncology have really advocated now in a recent publication for the integration of early palliative care for care of all patients with cancer.
I think it’s a step forward, we’ve got a long way to go but it’s a very exciting step and wouldn’t you personally, if you present to the healthcare system with a cancer, maybe with pain, and now we start treating you with medications that cause you to be nauseated, vomit, feel fatigued, not sleep well, wouldn’t you like to have the best of therapies to control that as well so you could continue to have the best possible life even while you’re undergoing treatment?
Here in Chile palliative care has been present for over 25 years and is really quite accepted for patients with cancer by the Ministry of Health and funded. So there are actually multiple programmes across the country.
The skill set that I’m seeing here is very high; the availability of medications is excellent and really the desire to move forward and have people receive early palliative care is very much present.