Cancer Mythbusters: Is Palliative Care Only for End-of-Life Patients?

Read the transcript:

MEGAN: Hi, I'm Megan Riesz, and this is Cancer Mythbusters, a podcast from Dana-Farber Cancer Institute about the many myths and misconceptions in the world of cancer. Every episode, we'll take a look at a myth and debunk it with the help of our world-leading clinicians and researchers.

For cancer patients and their families, who are often laser-focused on a cure and staying positive, the topic of palliative care can be scary to think about. Many people aren't even sure what it means.

In fact, this often-misunderstood specialty focuses not on curing disease but on improving quality of life for cancer patients throughout their disease. Still, many continue to equate it to hospice care, the goal of which is to help patients at end of life.

So, who is palliative care really for, and how can it help cancer patients of all ages?

Today, we're joined by Dr. James Tulsky, chair of Dana-Farber's department of Psychosocial Oncology and Palliative Care to clear up the confusion surrounding this medical approach and its use in cancer treatment.

MEGAN: Thanks for joining me, Dr. Tulsky.

DR. TULSKY: Thanks for having me.

MEGAN: Let's clear up the difference between palliative care and hospice. Is palliative care only for cancer patients at the end of their lives?

DR. TULSKY: Absolutely not. Palliative care is appropriate for patients at any stage in their illness. Honestly, for some people, from diagnosis all the way through to the end. And the reason is because we focus on the kinds of things that matter to patients throughout their illness, like managing their symptoms, taking care of pain, helping them think through decisions they need to make.

MEGAN: How does an appointment with a palliative care provider generally go?

DR. TULSKY: So, a typical appointment… For example, I could just say yesterday, I saw a new patient who has breast cancer and is being seen by our breast cancer team here. She came to me, and what that looked like was I just wanted to start learning about her life and finding out a lot about her, who she is as a person, and then what sorts of issues were on her mind.

She had a number of concerns. She has fatigue. She's been experiencing “chemo brain” and having trouble thinking about things and wanted some help with that. She also wanted to be able to think about the future and what that might mean to her and how she could best maximize her quality of life. She has young kids and is working with that.

The goal of that visit was really to learn about who she is as a person, how the disease is impacting her life, things that we might be able to do to help with that, and then some of the usual medical things. We might do a physical exam and then may, at the end, give some ideas about it or prescriptions to manage the various things that are coming up.

MEGAN: What are some of the things that palliative care providers can help patients with?

DR. TULSKY: I think the #1 reason that oncologists refer patients to us is for pain. We are experts in the management of pain, and the oncologists are great when the pain is relatively straightforward, but if it starts getting more complicated, if it starts requiring more different kinds of drugs than usual medications or usual interventions, we can be helpful in that way.

We also help manage some other symptoms. Typical ones are nausea, which, unfortunately, affects people both through treatment and sometimes afterwards. We also help frequently around issues with fatigue. We can help also, to some extent, with emotional health issues, people who are feeling depressed and anxious, and sometimes we then also look to our psychosocial oncology colleagues to help with those issues as well.

MEGAN: Why is it important to incorporate palliative care early in the treatment process?

DR. TULSKY: It's important to incorporate palliative care early in the course of disease because the longer we know you, the better we can help you. If we learn about who somebody really is early on in their illness, it gives us a lot more to work with as the disease plays out, and then we know you so much better. Although we talked about it not being something that's only about end of life, I want to tell one story about a patient I recently took care of who I think exemplifies this.

I saw a patient who had a brain tumor, and I saw her literally a few days after diagnosis. We had wonderful conversations about what was really important to her, and she was hoping to be cured, and she had very aggressive treatment, and I supported that hope because I was very much hoping she would get cured. At the same time, she was able to talk about what might happen if that wasn't the case. We spoke a lot about what was most important to her, about what mattered, her family, those kinds of things.

And as time went on, and as the disease, unfortunately, ended up progressing, we were able to revisit that conversation again and again, and I would say, "You told me on day 1 that this was most important. Does this treatment plan look like it's helping you get there."

And I'll actually share something that her husband said to me, which was very powerful. He said, at one point, "I get what you do. You're the guardian of our values."

And I thought that that was really spot-on. I knew what they really wanted, and in the course of everything else that was going on as it got really complicated and difficult, it was helpful for them to have that sounding board of somebody who knew what they had really been thinking early on and to make sure that they were still in touch with that.

MEGAN: Thanks so much for joining me, Dr. Tulsky.

DR. TULSKY: You're very welcome. My pleasure.

MEGAN: So, myth busted. Palliative care is not only for patients at end of life. It can help all kinds of cancer patients and families identify their values and plan for the future as they navigate cancer treatment.

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