Palliative care in advanced prostate cancer

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Published: 27 Nov 2013
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Dr Zipporah Ali - Kenya Hospices and Palliative Care Association (KEHPCA), Kenya

Palliative care in prostate cancer has become more important with an aging population and is now encompassing more than just physical pain. Metastatic prostate cancer is incurable and does cause significant morbidity, but the focus of treatment should be on improving quality of life through appropriate oncological treatment and palliative care.

Dr Ali discusses how palliative care involves managing symptoms that are physical, psychological, spiritual and social and involves those close to the patient.

I’m going to focus a lot on palliative care in prostate cancer and it’s actually about advanced prostate cancer. Most patients in African countries present at a late stage and mostly they’ll benefit a lot from palliative care, even if they present early, it’s also still applicable if they present early but we know that most of the cases come when it’s advanced. A lot of our doctors will focus on the physical issues of the patient and forget the psychosocial issues so really we’ll talking about a little bit of the physical problems that patients have, for example pain. Pain is very common in advanced cancer, especially bone pain, and one of the things we see is that we don’t treat this pain adequately, in fact most times we don’t treat the pain we ignore the pain and because, maybe, of the cultural issues people are supposed to live with pain, men are not supposed to complain of pain. So even the male patients will come and they will not talk about their pain and maybe that’s the reason why they came to the hospital. So I’m going to be talking a little bit about treating the pain, how it’s very important to treat the patients’ pain because that’s maybe the most distressing at that time or when they come it also might be the most distressing symptom.

Then I also talk about issues of sexuality because, again with prostate cancer, people when they get prostate cancer they get treatment that might affect their sexuality and we don’t usually communicate about sexuality. Patients want to ask questions but they’re embarrassed because of the way we have brought up all these issues of sexuality being something that they cannot talk about in public and also because, as healthcare providers, we are not really trained to talk to patients about their sexuality.

I’ll also focus a little bit on the psychosocial support, supporting the patient and the family to be able to cope with the disease, to live with the disease and, again, also just to improve the quality of life of the patient by really being there for the patient. Then the other thing, also, is at one time or other the patient will be dying so how do we support this dying patient? How do we support the patient, how do we support the family? How do we help them make decisions? Which way is the best care for them, is it in the hospital, at the house? When do we stop active treatment and concentrate on just focussing on palliative care and improving their quality of life?

What work is being done to train professionals and educate patients?

Different countries have different levels of really integrating this into their training. If I was to speak about my own country, Kenya, we are now training healthcare providers in palliative care. We have been going to government hospitals, for example, to start palliative care services and we train people there for a week. Our training will include those aspects of care, psychosocial aspects of care. We actually focus a lot on patient, doctor, nurse or family member communication, talking about that they need to communicate, they need to find out, they need to look at the patient holistically and look at the other aspects of their needs, not just the physical but what about their spiritual needs, their emotional needs? Even their financial needs are very important because most patients are worried they’ve used up all their money and they have no money left. So we’re actually trying to integrate that into our training, that people need to look at the patient holistically.

Are there any cultural issues when treating with drugs such as morphine?

Not necessarily cultural but I think the use of morphine is not as good as it should be, morphine or other pain killers, simply because people have not been trained to use those drugs, they don’t know how to use them, don’t know how to prescribe them. Also because of the regulatory issues that make it a little bit difficult for doctors to prescribe because they feel that if something goes wrong they might be taken to court. And the laws actually are friendly for prescribing the drugs but the attitude, the knowledge, skills are not really there in most of the healthcare providers so that’s one of the other things that we’re focussing on is training healthcare providers to be able to prescribe drugs. Also actually informing patients that they can actually talk about their pain, that they’re allowed to talk about their pain, that they should demand pain treatment, it’s a right for them, it’s a basic human right as well.