The common question I have encountered since coming back to the Philippines is “What is Palliative Care?”  And the common comments or insights I receive from colleagues and friends are “Is it the same as Hospice?”; “Is this pain management?”  Hence, coming up with a clear definition of Palliative Care that is relevant, simple to comprehend and even adaptable to the Philippines setting was one major task I needed to make.   

      Learning that the cancer patient population is the common group in which Palliative Care is currently being incorporated to the health care system of our country has allowed me to simplify and concretize what is Palliative Care.  Presently, I usually explain to colleagues and patients with cancer that Palliative Care is cancer care and support to the patient and their families.  But there is more to tell and share after connecting and linking up with them.  Allow me to share with you insights and key concepts of what is Palliative Care. 

      Palliative care is increasingly being recognized as a public health issue.  National and international government health care policy documents identify palliative care as an essential component of care and support for children, the elderly, patients with cancer, HIV/AIDS, neurodegenerative diseases, etc1.  

      The WHO Cancer, AIDS, and Aging Units as well as UN AIDS have conceptualized palliative care as a fully integrated component of a care system that provides concurrent disease treatment with an emphasis on patients’ quality of life by ensuring symptom control and supportive therapy combined, when possible, with disease-specific treatment1.  
 

      An expanded definition has been propagated by World Health Organization (WHO):2 Palliative Care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain, and other problems, physical, psychosocial, and spiritual.  Palliative care: 

• provides relief from pain and other distressing symptoms;
• affirms life and regards dying as a normal process;
• intends neither to hasten nor to postpone death;
• integrates the psychological and spiritual aspects of patient care;
• offers a support system to help patients live as actively as possible until death;
• offers a support system to help the family cope during the patient’s illness and in their own bereavement;
• uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;
• will enhance quality of life and may also positively influence the course of illness;
• is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.  

 

   Palliative care complements therapies that aim to cure or control the underlying disease process throughout an illness experience, not just at the end of life.  It is an integral part of comprehensive care for adult or pediatric patients presenting to the health care system with life limiting illnesses (Fig 1).3 
 

 

 

 

  Figure 1. Focus of care. 
 

      An aging population, a growing incidence and prevalence of cancer, and an exploding HIV/AIDS epidemic has brought increased attention on palliative care as a public health issue.4   

      Each year, worldwide, 10 million people are diagnosed with cancer and six million die from the disease.  Global cancer rates will increase by 50% from 10 million in 2002 to 15 million new cases in 2020.  Fifty percent of the world’s new cancer cases are now occurring in developing countries, and 80% of these individuals are already incurable at the time of diagnosis.1   

      As health care system evolve in developing countries, palliative care presents an opportunity for policy makers, funders, clinicians, and community organizations to immediately provide cost-effective care that will have a significant effect on the lives of patients and families living with advancing illness, while they improve their country’s capacity for prevention, early detection, and treatment. 

      For all cancer control programs, primary prevention, early detection, curative treatment, and palliative care are the four key components (pillars) of comprehensive cancer care (Fig.2).5 

   Figure 2.  Pillars of a National Cancer Control Program 

      Palliative Care has a universal value for all patients, whether they are receiving treatments with curative intent or not.  It has been shown to improve quality of life, enhance patients’ capacity to live optimally, and be cost-effective when it is an integral part of the comprehensive cancer care.

      For many countries where a significant number of patients are presenting with stage III or IV cancer, for which curative care is not available, palliative care, with or without palliative chemotherapy, radiotherapy, and surgery, will be very important to offer.  For these patients, palliative care alone offers a therapeutic approach that will improve quality of life and save patients from overtreatment, high morbidity, and wastage of resources when their cancers are incurable. 5  

      In countries where patients are presenting with early-stage cancers, palliative care will also be an important component of comprehensive cancer care from the time of presentation until death, whether the patient is receiving curative treatment, or not.  Thus, a national policy introducing palliative care for all patients at the time of diagnosis will be as important as incorporating primary prevention and curative therapy, coupled with effective early detection, into National Cancer Control Programs.  No cancer center can be classified as comprehensive without integrating palliative care throughout the patient’s illness experience.5 
 

REFERENCES

1. Callaway M., Ferris FD.  Advancing Palliative Care: the Public Health Perspective. Journal of Pain and Symptom Management.  May 2007; Vol. 33 (5): pp.483-485.
2. WHO Definition of Palliative.  Available from http://www.who.int/cancer/palliative/definition/en.
3. Ferris F, Balfour H, Bowen K, Farley J, et al.  A model to guide patient and family care.  Based on nationally accepted principles and norms of practice. Journal Pain and Symptom Management 2002; Vol. 24(2): p.115. 
4. Stjernsward J, Clark D.  Palliative Medicine – a global perspective. In: Doyle D, Hanks GWC, Cherny N, Calman KC, eds. Oxford textbook of palliative medicine, 3rd ed.  Oxford: Oxford University Press, 2003, pp. 1199-1224.
5. Stjernsward J, Foley K, Ferris F.  Integrating Palliative Care into National Policies.  Journal of Pain and Symptom Management.  May 2007; Vol.33 (5): pp.514-520.