Talking about cancer discoloration, not only because of its high mortality, but also the uncomfortable symptoms that accompany the late stage of cancer: psychological disorders, malnutrition, pain, loss of appetite, weight loss, decreased physical strength, etc. In clinical practice, the problem that patients often need to solve is to control pain and improve nutritional status on the basis of anti-tumor therapy, so as to enter society with a healthy body and mind. This is about palliative care for cancer. In clinical practice, patients or family members will always ask: What is palliative care? Is palliative care a hospice care?
In fact, the word “palliative” in palliative care is not the literal meaning of “palliative and nourishing traitors”, it actually refers to the “full and active” intervention of the disease. The World Health Organization (WHO) defines palliative care as: Palliative care medicine is complete and active treatment and care for those patients who do not respond to curative treatment. Including control of pain and related symptoms of patients, and paying attention to psychological, social and spiritual problems. Its purpose is to win the best quality of life for patients and their families. In the comprehensive plan of oncology work, WHO has identified four key points: prevention, early diagnosis, radical treatment and palliative care. This shows that palliative care is an essential part of cancer control.
Palliative care can run through the whole process of anti-cancer treatment
Palliative care can be intervened from the beginning of cancer diagnosis and throughout the entire treatment process. The main content is to implement appropriate anti-tumor treatment methods, such as surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy, and other active anti-tumor treatment methods, when the patient’s body and disease allow it. The purpose is to control tumor growth as much as possible, improve symptoms, prevent disease progression, prolong patient survival time, and ultimately improve the quality of life.
Palliative care in surgical treatment, the main intervention areas include perioperative nutritional support, pain management, psychological guidance and postoperative rehabilitation guidance. Allow patients to receive anti-cancer treatments in a soothing mood, and at the same time alleviate pain and nutritional and metabolic disorders caused by surgery. For advanced cancers that cannot be cured, all anti-tumor treatments are palliative treatments.
Pain control is the main feature of palliative care
Among patients with malignant tumors receiving treatment, 51.1% of patients had pain of varying degrees, 70% of patients with advanced malignancies had pain as the main symptom, and 30% of patients with malignant tumors had severe pain that was intolerable. Pain causes or aggravates a series of uncomfortable symptoms in patients: anxiety, depression, fear, insomnia, irritability, etc., which seriously affect the quality of life and mental health of patients. Since the WHO put forward the “three steps of cancer pain treatment” in 1986, cancer pain treatment has gradually been standardized, but there are still more than 50% of cancer pain patients whose pain has not been effectively relieved.
Palliative care is characterized by pain control, strictly in accordance with the principle of “three steps of cancer pain treatment”, combined with the patient’s own condition, through scientific cancer pain scores, and appropriate, regular, and individualized medications to reduce the pain of patients from severe pain to Mild pain, mild pain reduced to no pain, greatly reducing the suffering of patients. For cancer patients, “painless” represents the improvement of survival status and a more positive treatment attitude. Many patients showed a positive attitude to overcome cancer after pain control, which significantly improved their quality of life.
Nutritional support is also first-line treatment
The incidence of malnutrition in patients with malignant tumors is as high as 40% to 80%, and its degree is related to the type, location, size, and stage of the tumor. 31% to 87% of patients with malignant tumors have lost weight before diagnosis. For example, the incidence of weight loss and malnutrition in patients with esophageal cancer is as high as 80%, about 33% to 75% of patients with malignant tumors have anorexia, and about 30% to 85% of cancer patients develop cancer cachexia, the most likely to develop cachexia Of patients with gastric cancer, pancreatic cancer and esophageal cancer, about 80%.
Patients with moderate to severe malnutrition have poor tolerance to anti-cancer treatments, the effective rate of anti-tumor treatments decreases, and at the same time increases the corresponding toxic and side effects, so it is extremely important to improve the nutritional status of patients. Nutrition is not a simple support, let alone a supplement, but a treatment. The United States proposed in the 1980s that nutrition is the treatment and the ultimate solution to chronic diseases. Canada also proposed that nutrition is the first-line treatment. Through nutritional support therapy, the patient’s tolerance to anti-tumor therapy can be significantly improved, and even the effective rate of anti-tumor therapy can be improved.
Palliative care incorporates nutrition into an extremely important part of treatment, forming a complete nutrition therapy system for cancer patients, through admissions nutrition screening, professional nutritional status score, multidisciplinary collaborative diagnosis and treatment, and nutritionist on-demand and individualized delivery With parenteral nutrition therapy, the nutritional status of most advanced cancer patients can be improved, and the anti-tumor treatment can be supported by a better body.
Psychological counseling is essential
Cancer patients usually experience changes in 4 psychological stages-
1. Shock-Fear: The first time you learn about cancer, you will be frightened, accompanied by palpitation, dizziness and syncope, and even stupor.
2. Denial-Doubt: When the patient calms down from a violent emotional shock, he will respond with the denial mechanism. Try to deny the doctor’s diagnosis and seek verification everywhere in order to get a negative result.
3. Anger-frustration: When the patient knows that the cancer diagnosis cannot be changed, the emotions will become irritable, angry and even aggressive; at the same time, sadness and depression will arise spontaneously, despair, and some will have suicidal thoughts or suicidal behaviors.
4. Depression-Pain: The fact of illness cannot be changed. Patients will eventually accept and adapt to the fact of cancer, but most of them will enter chronic depression and pain. In addition, side effects during cancer treatment will also have an impact on patients’ psychology.
Therefore, psychological counseling for patients with advanced cancer is very important. Palliative care is usually equipped with a psychologist to guide and intervene according to the psychological problems presented by individual patients: mainly include vent therapy, confidence therapy, and diversion methods to help patients relieve bad emotions and make patients full of confidence in fighting cancer.
Palliative care ≠ hospice care
Palliative care was first proposed from hospice care. It was believed that palliative care meant that a person was about to die, and the comfort and care given during the dying. But the two are not equivalent. With the development of palliative care, its meaning and adaptability have been continuously expanded. Hospice care is only the final part of palliative care. At present, early palliative care is actively advocated and implemented at home and abroad, and it is accompanied by the entire process of tumor diagnosis and treatment, even in certain areas. These stages should become the main treatment method, until the patient’s dignity dies and later bereavement services.
In short, many patients do not understand the true meaning of palliative care and come to the hospital with a desperate attitude. However, after a series of treatments such as anti-tumor treatment, pain control, relieving bad mood, and improving nutritional status, various painful symptoms Under effective control, they re-gathered the courage to live. This is the meaning of palliative care.
>>Expanded link to the three steps of cancer pain treatment
The first step: non-opioid analgesics, for patients with mild cancer pain, adjuvant drugs can be used as appropriate.
Second step: weak opioid analgesics, used when non-opioid analgesics are not satisfactory for pain relief, or for patients with moderate cancer pain. It is generally recommended to combine with the first step drugs because the two types of drugs have different mechanisms of action. The first step drugs mainly act on the peripheral nervous system, and the second step drugs mainly act on the central nervous system. The combination of the two can enhance the analgesic effect. Adjuvant drugs can also be used as needed.
The third step: strong opioid analgesics, used to treat moderate or severe cancer pain, used when the first and second steps have poor efficacy, the main drug is morphine, and adjuvant drugs can also be used as appropriate.
Yuhui Qing chief physician, Professor, master tutor. The current director of the Department of Palliative Medicine in the Cancer Hospital of Chongqing University, the director of the Cancer Nutrition Diagnosis and Treatment Center, the teaching director of the Department of Medical Oncology, the chief expert of the MDT team of tumor clinical nutrition therapy, the medical high-end talents of the Chongqing University Cancer Hospital, Chongqing Talents-Innovation Leaders . It is the first in Chongqing to propose and implement the “five complete” diagnosis and treatment concept of “whole person, whole process, whole team, whole family, and whole society” for cancer patients, and is committed to practicing comfortable medicine. He is good at chemotherapy, molecular targeted therapy, immunotherapy and comprehensive diagnosis and treatment of malignant tumors such as lung cancer, stomach cancer, colorectal cancer, liver cancer, lymphoma, etc., and is also committed to clinical research on precise analgesia and tumor nutrition.