Palliative Care: Symptoms and Quality of Life

What is it?

Palliative care aims to reduce the symptoms caused by cancer or its treatment and to support the person in living according to their own priorities. It is not a service left to the last days of care. The World Health Organization defines it as the early recognition and relief of suffering in life-threatening disease.

Palliative care can be added while active tumour treatment continues. ASCO recommends that palliative care join standard oncology care early in advanced cancer. This does not mean giving up treatment. Symptom control also affects whether a person can continue treatment.

How does it work?

A stepwise drug approach is used for pain. One may start with paracetamol or a non-steroidal drug and move to an opioid when needed. The dose is adjusted together with opioid effects such as constipation and nausea. In shortness of breath the cause is sought, and oxygen or a low-dose opioid may be discussed.

Nutrition, sleep, depression, caregiver fatigue and talking about goals are part of the same framework. The aim is to preserve whatever the person is able to keep doing.

In which cancers is it used?

It has a place in every cancer type in which there are symptoms. Pain in pancreatic cancer, shortness of breath in lung cancer and bowel obstruction in abdominal tumours are frequent examples. Even in early stages, support may be needed for treatment side effects.

Which treatment is appropriate is discussed at the tumour board, with the relevant specialties taking part, by considering the type, stage and molecular features of the cancer and the person’s general condition together. Algology can be called in for pain, a dietitian for nutrition and psychology for emotional support.

How is it given?

At the outpatient check-up, symptom scores are asked about. Medicines are taken at set times at home. In complex pain, a palliative care or algology consultation is requested. Some hospitals have a separate palliative care outpatient clinic.

When the aim of treatment changes, for example when tumour drugs no longer bring benefit, the care plan is discussed again. This conversation does not have to be rushed or finished in a single visit.

During follow-up, blood tests, imaging and symptom review are read together. The dose or date may be changed according to side effects and organ function. The list of medicines used at home is updated at every visit. Sudden fever, shortness of breath, uncontrolled diarrhoea or bleeding should be reported the same day.

Possible side effects

Palliative care itself is not a procedure. The medicines used have effects. Opioids can cause constipation, drowsiness and nausea. Corticosteroids can open the appetite while disturbing sleep and blood sugar. A laxative is considered on the day an opioid is started.

A sudden increase in pain, a new neurological symptom or slowed breathing after a drug is assessed the same day.