Nearly 80% of cancer patients, including children, get aggressive treatment like chemotherapy, radiotherapy and sometimes a combination of both as they near the end of life. However, only half of them get referred to palliative care, which could offer them the much-needed relief from the tumour-specific treatment, a recently-published study has revealed.
Palliative care consists of symptom-relief interventions for pain, shortness of breath, nausea, anxiety, wound care, counselling and spiritual care.
The study looked at medical records of 96 patients (52 adults and 44 paediatric) who succumbed between April 1 and September 30, 2016, at a government-run hospital in Hyderabad due to haematological malignancies such as leukaemia and lymphoma, and solid tumours. The study showed that 39 adults and 38 paediatric patients were given tumour-specific treatment during the last 30 days of their life; 26 adults and 25 paediatric patients received the aggressive treatment in the last seven days while the same number of patients were referred to the hospital’s palliative care unit. As many as 11 adults and 13 paediatric patients received tumour-specific treatment on the day of death or one day prior.
“Continuation or initiation of tumour-specific treatment, mainly chemotherapy, close to the end of life is correlated with impaired quality of life near death. Despite this, it is not unusual to see tumour-specific treatment in the last 30 days of life,” the study, published in the Journal of Palliative Medicine in May,said.
Cancer therapy, it said, has become more aggressive during the past decade. “Our aim was to study the kind of access to palliative care and see how many patients, especially children, get referred to the palliative care department,” said Hyderabad-based medical oncologist Dr. Sudha Sinha, the lead author. “What we saw was that access to palliative care, even in a set-up where a palliative care department existed, was not 100%,” she said. The first-of-its-kind study reflects the scenario across the country.
An integrated approach
According to Dr. Sinha, there is an urgent need to integrate palliative care with curative care. “At no point should the treatment be stopped. Especially in children with cancer, there is a huge scope of recovery even in severe cases. But palliative care should be started simultaneously.”
Palliative care expert Dr. Gayatri Palat, co-author of the study, hoped the findings would trigger two areas of introspection: Can we offer palliative care while the disease is being treated, and can questions be raised about when the aggressive treatment be stopped? “It is an extremely delicate subject. But physicians have to start discussing among themselves and with family members as to whether the treatment can be stopped at a certain point,” said Dr. Palat. “What would a patient want? Will he want to spend the last one month or one week in hospital or at home with his loved ones?”
Blood transfusions, pumping of antibiotics and so on in the last stage does very little for patients, said Dr. Palat.
Dr. M.R. Rajagopal, founder chairman of Pallium India, a palliative care non-governmental organisation in Kerala, said the study reflects the drawback of not having palliative medicine as part of the medical syllabus in India.
Mumbai-based radiation oncologist Dr. Nagraj Huilgol, who is also the president of the Society for the Right To Die With Dignity, said people must understand the idea of futility. “I am not surprised by the findings of the study. The relatives and doctors often push for treatment. But one must understand the limitations of treatment, and the palliative aspect should be brought in.”
