One day, Ranjana*, a homemaker, noticed a lump on her left breast. It was painless initially, but soon Ranjana suffered intense pain and dizziness. A visit to the doctor revealed advanced breast cancer. By this time, physical discomfort caused Ranjana to limit her social interaction. In the next few weeks, the lump ruptured and there was a foul-smelling wound. Her discomfort reached a point that she even contemplated discontinuing her treatment.
This turnaround is typical of many cancer patients. Patients, especially those suffering from advanced stages of cancer, often suffer debilitating pain. In such cases, pain management becomes essential. Contrary to popular belief, pain management should be proactive and dedicated instead of being an accompanying treatment. Managing pain leads to an increased likelihood of the patient continuing the treatment. This, in turn, leads to improved survival or offers an improved quality of life when cancer becomes incurable.
There are many ways to manage pain caused by cancer through drugs or Interventional Pain Management. But pain management is not the only thing to be taken care of. Cancer and its treatment can often cause psychological turmoil, social stigma, occupational and legal concerns, and spiritual/religious issues. Though managing pain is important, these concerns must also be addressed to ensure the well-being of patients and families.
This is where palliative care is required. Palliative care is defined as a specialised, multidisciplinary medical care meant as an additional form of treatment for cancer patients and their families to help cope with the issues arising out of cancer diagnosis and treatment.
Utilising a team of specialists like pain specialists, oncologists, physicians, psychologists, nurses and spiritual consultants, palliative cancer care aims at addressing psychological, social, occupational, legal and spiritual issues.
Ranjana and her family were inducted into a palliative care programme, which provided them prevention and relief through examination and treatment of distressing symptoms along with spiritual and psychological counselling, apart from the pain management programme. The results were encouraging. Within a month the pain levels had reduced and the patient had a more positive outlook towards life.
Palliative care experts aspire to provide “total pain relief”, focusing not only on physical discomfort but also on psycho-socio-spiritual “pain”. In addition to managing pain and other symptoms, techniques like yoga, meditation, emotional counselling, family meetings, and spiritual guidance are offered to ensure that patients and families enjoy a better quality of life during and after treatment. Patients under palliative care enjoy quality lifespan and are able to perform daily activities better than those without.
Despite its obvious benefits, palliative cancer care in India has not grown due to two reasons; lack of awareness and lack of infrastructure. Many oncologists are either not aware of palliative care, or do not recommend it to patients due to the lack of quality infrastructure. The lack of pain and palliative cancer care specialists is also a major factor; only a handful of doctors specialise in this sector.
However, the situation is improving. The Indian Association of Palliative Care, the central body for palliative care in India, is offering courses to educate health service providers in palliative therapy. A few hospitals have launched their own pain management and palliative care wings.
Since her introduction to palliative management, Ranjana has been able to lead a more productive life. Pain and palliative care management has gained a widespread acclaim worldwide due to its benefits. In India too, the practice is gaining strength, though much work needs to be done.
