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When you hear someone is “battling cancer,” their fight is against more than the disease itself. Sometimes, they’re also battling the side effects of treatment. And they’re battling the emotional distress from worrying about how their diagnosis will affect their lifestyle, family, or finances.

Cancer is a war waged on many fronts. Palliative care is part of the army that joins the fight.

What is palliative care?

Palliative care is specialized medical care for people living with a serious illness. Also known as supportive care, palliative care is offered alongside active treatment to relieve pain and other symptoms and improve the quality of life for the patient and their family.

Patients of any age and disease stage can access palliative care services. These services include medical, social, emotional, and spiritual support provided by doctors, nurses, and other professionals. Palliative care providers coordinate care with the patients’ other doctors to complement ongoing treatment.

Palliative care providers also can help patients understand their treatment options and decisions regarding their care. These conversations focus on patients’ values and desires for themselves and their loved ones.

“It’s understanding everything so that patients can make informed decisions, whether it’s treatment, non-treatment, or other aspects of their care,” says Summit Health palliative care physician Paola Reveco, DO.

While palliative care is helpful at any time, early intervention is ideal. Research shows early integration of palliative care for cancer patients improves quality of life, mood, health care utilization, and overall survival.

Personalized, compassionate care

A patient’s medical oncologist or radiation oncologist typically recommends palliative care. Services at Summit Health are provided in an outpatient setting and delivered with a coordinated, multidisciplinary approach.

Dr. Reveco says some patients are hesitant when they hear “palliative care” because they think it’s the same as hospice care. “There’s a conflation between the two,” she says. “Palliative care doesn’t take away or preclude treatments and therapies for cancer. It’s active treatment with symptoms management and helping to get you through all you’re experiencing.”

Meeting with a palliative care provider allows a patient to address pain and other symptoms— and process their diagnosis, Dr. Reveco says. “They’re digesting a lot of medical terminology and want to understand what it really means. ‘What does it mean to go through chemo? Can I still work? Can I still do what brings me joy?’—questions they may not think to ask right away.”

Dr. Reveco says she also makes sure patients understand who comprises their medical team, what they do, and what to expect. She acknowledges the balance between hope and the realities of battling cancer. “I’m not here to take away hope, but I want you to be prepared.”

KarLeung Siu, MD, is a medical oncologist who works with Dr. Reveco and other specialists to integrate palliative care. “I try to establish reasonable goals of care while maintaining hope for a good outcome,” he says. “This makes incorporating other team members within palliative goals much more seamless.”

Radiation oncology and palliative care

While radiation is often used as part of a treatment plan to cure cancer, it can also be used to reduce symptoms and improve function in patients who have incurable cancer. Radiation oncologist Andrew Wong, MD, engages in these goals by providing targeted, noninvasive treatment. “When our intent is palliative, we typically administer shorter courses with lower total doses [of radiation] that should be sufficient to achieve symptom relief with a low chance of developing side effects,” he says.

Dr. Wong says his team is often called to provide palliative radiation treatments for patients whose cancer has spread to the brain or spine. Treatments are targeted to a specific body area and can relieve symptoms such as pain, bleeding, and obstructions causing breathing or swallowing problems.

Since radiation treatment can cause side effects such as pain or nausea, Dr. Reveco stays in the loop to help monitor for and manage any that may occur.

This type of coordination extends to other specialists who further support palliative goals in certain cases. “Although radiation therapy is very effective in alleviating pain from bony involvement of cancers, relief onset may take days to weeks,” says Dr. Wong. “In the interim, we work with colleagues from pain management, palliative care, and interventional radiology to provide more immediate pain relief while radiation treatment takes effect.”

Interventional radiology and palliative care

Interventional radiology is a medical subspecialty utilizing minimally invasive, image-guided procedures to diagnose and treat various diseases. Waseem Bhatti, MD, and Joseph DeMarco, DO, are among Summit Health’s interventional radiology specialists who can provide expertise when palliative needs arise.

Drs. Bhatti and DeMarco describe a few examples of interventional radiology treatments for cancer-related pain.

  • Nerve blocks are injected medications that prevent specific nerves from sending pain signals to the brain. These procedures can help reduce chronic abdominal pain or pelvic pain, for example.
  • Cementoplasty is the injection of a special cement to repair bone where cancer has spread, such as the pelvis, shoulder, or spine.
  • Catheter placements drain fluid build-up around the lungs (pleural effusion) or in the abdomen (ascites).
  • Cryoablation is a procedure that can freeze/kill tumors or freeze/block nerve conduction, leading to longer term pain relief.

Like radiation oncology, patients can receive treatments conveniently in a non-hospital setting. “Patients are able to go home within hours of the procedure,” Dr. DeMarco adds.

Connected cancer care

Advancing palliative goals takes a multidisciplinary approach that all the physicians describe with conviction. “This interaction between oncologists, palliative care, interventional radiology, radiation oncology, and pain management is crucial to developing an individualized plan for each patient,” says Dr. DeMarco.

In addition to meeting with patients individually, physicians regularly reach out across specialties to share information and confer on next steps. One avenue for communication is tumor board sessions when a multidisciplinary group of providers gathers to discuss patient cases. Dr. Reveco launched a palliative-focused tumor board at Summit Health as an additional forum for collaboration.

Dr. Bhatti highlights how technology further supports information-sharing and direct communication. “Our offices are linked with one another using the Athena electronic health record system, so referrals, patient notes, imaging, and lab results can be shared seamlessly.” Along with email and virtual conferencing, he adds, the communication tools “help us coordinate care at a level not commonly seen in other practices.”

 “Sometimes the best treatment option involves more than one specialty,” says Dr. DeMarco. “In these cases, our individual departments coordinate to get the patient care as quickly as possible.”

Focusing on what matters most

The extra layer of support that team-based palliative care provides benefits patients and their families. Family members can participate in appointments and access resources that relieve burdens and help plan for the future.

“The family is a great window to how the patient’s really feeling,” says Dr. Reveco, noting they sometimes surface issues she can help with and keep loved ones accountable.

Palliative care’s focus on the quality of life is a powerful weapon in battling cancer. “Cancer is a journey, and there has to be a goal,” says Dr. Reveco. “We’re homing in on what’s important to a patient. I’m here to make sure what’s important to them remains important.”

“As a patient with cancer, you are undergoing an incredible fight,” says Dr. DeMarco. “If you have pain, let your oncologist know. We have many tools at our disposal.”