Note by Dr Suraj Manjunath: This is a guest post by Dr Vivekanandan Jayakumar. The article describes how patients with advanced incurable cancer should realize that there is a lot that can be done to give them a good quality of life. Dr Vivekanandan is a highly skilled cancer surgeon who is exceptionally dedicated to his patients, and it has been a pleasure for me to work with him in the Department of Surgical Oncology at Vikram Hospital, Bangalore.
A diagnosis of incurable cancer is one of the most devastating pieces of information that can be given to a patient and their family. While our advances in the fight against cancers with ever-increasing cure rates and cutting-edge technologies are well known, many are unaware that incurable cancer does not mean the end of treatment.
The patient and their loving families run from pillar to post, taking multiple opinions from oncologists who all say the same thing, ‘That there is no further treatment.’ Sometimes, they hear different numbers (O.1% vs 1% survival) and go above and beyond for “state-of-the-art treatment” (State of the art may not equate to standard or even effective treatment). These treatments come with side effects and are quite taxing on a common man’s pocket and most of the time do not help much.
While the term “incurable cancer” feels like the treating clinician does not have any further options to care for the ailing patient, it is far from the truth. A patient with terminal cancer still has a myriad of symptoms that affect their quality of life. The answer to families in this dilemma is Palliative Care. Palliative Care makes every effort to help them lead a normal life as much as possible and improve the number of good days. Palliative care is often perceived as End of Life care whereas research suggests that early involvement of Palliative Care prolongs not just the quality but also the length of life.1
This part of care unlike other prescriptive medicine can be flexible and tailored according to the needs of the individual patient and their families. The first step is identifying the key issues which are ensured through open communication. The need for information and the curiosity to know about their own health sometimes drives a wedge between patients and family members (imagine a parent refusing life-prolonging treatment whereas the children wish to do anything to prolong the parent’s life). The palliative care team is trained to deal with these complicated conversations. The next steps would be managing expectations of their current situation, creating an acceptable care plan which not only addresses the physical issues but also the emotional, social, and spiritual suffering. Palliative care is all-encompassing, aiming to care both for the patient and family depending on their setting at a hospital, patient’s home, or a specialized care facility (Hospice). The care does not end there but continues through the grief and bereavement of the family. Our sole aim should be to keep the patient as comfortable as possible and as long as possible to allow them to face the final phase with all the dignity they deserve.