Remember palliative care on World Cancer Day

Categories: Care.

Hospice and palliative care has for a long time been associated with addressing cancer, with the modern hospice movement starting with Dame Cicely Saunders’ drive to care for patients with this disease. The health care system had dismissed these patients, saying: “There is nothing more we can do,” sending them home to die in physical, social and spiritual pain.

Since that time, hospice and palliative care has extended to many more diseases, such as Alzheimer’s and other dementias, cardiovascular diseases, cirrhosis of the liver, chronic obstructive pulmonary diseases, diabetes, HIV/AIDS, kidney failure, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, and drug-resistant tuberculosis (TB) (WHO/WPCA).

Cancer still makes up just over 34% of adult palliative care patients’ diagnoses, and 5.69% of the diagnoses of child palliative care patients (WHO/WPCA).

The World Health Organization has expressed its commitment to reducing cancer and other NCDs, through the Global NCD Action Plan 2013-20, stating that: “For comprehensive care of noncommunicable diseases all people require access, without discrimination, to a nationally determined set of promotive, preventive, curative, rehabilitative and palliative basic health services.” The WHO also included palliation as a key component in its definition of Universal Health Coverage.

The theme of this year’s World Cancer Day is: ‘Debunk the myths,’ aiming to educate people on the myths and facts about cancer. The campaign focusses on the following myths:

  1. We don’t need to talk about cancer
  2. Cancer… there are no signs and symptoms
  3. There is nothing I can do about cancer, and
  4. I don’t have the right to cancer care.

Palliative care has been included in the answer to the fourth myth, stating that: ‘In many cases the largest and most unacceptable gap in cancer care is the lack of adequate palliative care and access to pain relief.’ This is certainly true, and access to appropriate pain medications remains a major focus for palliative care advocates internationally.

The third myth that has been chosen to debunk is: ‘There is nothing I can do about cancer.’ This statement echoes the reaction of medical professionals to Dame Cicely’s first patients, which tragically is still all too common today. Without an awareness of palliative care among medical professionals, patients are told: Go home, there is nothing we can do for you.

The essence of palliative care is that there IS something that health and social care workers, patients, families and communities can do. The multidisciplinary palliative care team, along with the patient and their families and community support system, surrounds the patient with a plan for care, comfort and pain management that is focussed on quality of life, moving the focus away from cure and therefore away from the hopelessness of the words: ‘There is nothing more we can do.’

A major problem in many countries around the world is that patients will present too late for cure, often with stage three or four cancer. It is important to recognise the role that palliative care can play, not only in caring for these patients, but also in educating their families and communities about cancer risk factors and risk-reduction and screening measures.

The fact sheet provided by the World Cancer Day team is focussed on action that individuals can take to change their behaviour and avoid developing cancer. However, it is important also to recognise the role that palliative care providers, particularly home care teams can play in education for cancer risk reduction.

A senior advisor at the World Health Organization, said: “I’ve seen that people who are trained in palliative care are also given notions of prevention and detection, so they understand that they can also be vehicles for promoting that kind of attitude in the community. For example, if you are caring for a patient who already has oral cancer linked to tobacco chewing, it is very important to educate the family caregivers about the importance of stopping this habit which is so damaging.”

The Executive Board of the World Health Organization has adopted a declaration entitled: ‘Strengthening of palliative care as a component of integrated treatment within the continuum of care,’ recognising the importance of an integrated approach to health care, including palliative care as part of prevention and treatment, as well as a specialty in its own right.

Much of the language that is used to speak about cancer contains metaphors of fighting, war and battle. While these metaphors are helpful for certain people (IOEOLC), they contain an implicit notion of failure, should the patient eventually die of the disease. This has led to the idea that to accept palliative and hospice care is an admission of weakness and defeat.

Therefore, one of the myths that needs to be debunked is that palliative care is certainly not giving up, but rather an active pursuit of the highest possible quality of life of the patient, in consultation with the palliative care team and the rest of their community.

Read more about World Cancer Day and find out about events happening near you on the World Cancer Day website.

Sign the World Cancer Declaration online.

The International Agency for Research on Cancer of the World Health Organization has released the World Cancer Report 2014. The report is downloadable in print or ePUB format. Prices start at US$39.

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