Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Cancer Care

Santa Clara Medical Center

News & Events

Dr. Pan and Dr. Lee's Blog

Palliative Care, Is it a Good Thing?

Oct 01, 2010

The most difficult thing for me to tell a patient and their family in their first visit is that the cancer is not curable. And it does not get easier for me to tell a patient who I have cared for months or years that their relapsed cancer is not curable. Yet, we all have limited years to live, and at a certain point, what we value most may not be how long we want to live, but how well we want to live, both physically and spiritually.

When we say “not curable,” it means that the cancer can predictably take a patient’s life if he or she does not die from other medical illnesses. It does not mean “not treatable.”

In fact, many advanced, stage IV metastatic cancers are treatable and a patient may live for months to years with treatment despite having cancer (some patients with stage IV lymphoma or testicular cancer can even be cured). The medical advances over the past several years have improved the survival length of many types of cancer.

But eventually, the non-curable advanced cancer progresses and treatment becomes less and less effective, and treatment side effects become more and more difficult for a patient to sustain. A patient can die from cancer, but can also die from treatment complications, or from infection or other cancer-related complications.

We value our patient’s quality of life very much, not just their length of living. This is the part of “how well we want to live.” All of us have a tendency to want to live as long as possible, but we also want to live a life with minimal suffering.

Yet, cancer can cause a lot of suffering towards the end. This suffering could be physical, such as pain, vomiting, extreme weakness, bowel or urine incontinence, and many others.  Or it could be mental, such as depression, anxiety, and fear.

From the conversations that I have had with patients, coworkers, and friends, almost all of them have informed me that if they are ever at a point of suffering from a non-curable cancer, they would prefer to live with reasonably good quality of life rather than to live to the point where they lose control physically and mentally, or suffer from the symptoms that I mentioned above.

It is at this point, that we initiate “Palliative Care,” a term that means minimizing suffering as much as possible and improving quality of life as much as possible. To minimize pain, anxiety, depression, fear and other discomforts; to provide as much peace as possible.

Some people interpret “Palliative Care” as “giving up”. This is not completely incorrect. At a certain point, we do have to “give up” aggressive treatment of cancer, and focus on preserving quality of life. As I said earlier, cancer treatment itself can cause many side effects that can often greatly impair one’s quality of life. But palliative care really does not mean “giving up” in its whole meaning. It means a different phase of care and a different level of care.

But when do we initiate palliative care? Do we wait until the very last days or weeks of life to get started? Occasionally when I begin my discussion with a patient and their family about starting hospice care, I am often told that they are handling the situation “OK” by themselves and do not want hospice care to start until the patient has become really sick and needs help.

Well, I should take one step back. “Palliative Care” does not mean just “Hospice Care”. “Hospice Care” is a part of palliative care. I often urge my patients and their families to start hospice care sooner rather than later, so they can establish a relationship with the hospice care nurse, get to know each other, and get help when needed, and not have to wait until the last minute to scramble to set up the care.

When do we start palliative care for a patient? Do we wait until a certain point when a patient is really declining quickly to begin that discussion?

A recent article in New England Journal of Medicine sheds light on this critical issue. This study, conducted at the Massachusetts General Hospital in Boston, included 151 patients with advanced non-small cell lung cancer, and divided them into two groups randomly (called randomization, to minimize introducing bias into the study), one group received the standard of care for the cancer and the other early palliative care in addition to the standard of care. The standard of care included chemotherapy and other anti-cancer treatments appropriate for their cancer and condition.

The early palliative care in this study included meeting with a member of the palliative care team, which consisted of board-certified palliative care physicians and advanced-practice nurses, within 3 weeks after enrollment and at least monthly thereafter in the outpatient setting until death. Additional visits with the palliative care service were scheduled at the discretion of the patient, oncologist, or palliative care provider.

The patients in the group of the standard of care only without early palliative care were not scheduled to meet with the palliative care service unless a meeting was requested by the patient, the family, or the oncologist.

The result from this study showed those patients who started early palliative care in addition to the standard of care had a better quality of life. In addition, fewer patients in the early palliative care group than in the standard care group had depressive symptoms. Despite the fact that fewer patients in the early palliative care group than in the standard care group received aggressive end-of-life care, on average, patients receiving early palliative care lived two and half months longer.

What does this study mean? Does it mean we should put all patients with advanced lung cancer into palliative care and not provide anti-cancer treatment? No.

It means, for those patients with advanced lung cancer in good physical condition and willing to consider anti-cancer treatment such chemotherapy; setting up palliative care early can still help them. At certain points, the treatment for cancer may not work any more, or the side effects may be too much to be tolerated.  At this point, continuing palliative care that is already set up becomes the continuum of care. Patients and families are more prepared, knowing that no matter what happens, there is a team standing by to help them. They are not alone.

For patients who are not interested in chemotherapy or other type of anti-cancer treatment, or are too ill to consider anti-cancer treatment, setting up palliative care as early as possible is undoubtedly very important. As I said earlier, waiting until the last minute often causes much anxiety to patients and their families, the care may not be set up when needed, and patients and families can suffer while waiting for the care to be set up and delivered.

One important part of palliative care is to discuss and fill out an Advance Directive form.  Advance directives set forth an opportunity for patients to plan for future medical care in the event that they become unable to make decisions, and allow patients to discuss with healthcare professionals about their medical care, including life-sustaining treatments.  This form can be very helpful to your family who may have to make important decision for you at certain point.

I have seen some families of patients of mine sustain great pain in making decisions for their loved ones towards the end of life when they were not prepared. Some patients were intubated (tube placed down their airway) and placed on a ventilator (machine to help breathe) to sustain their life when it was obvious that the efforts would be futile. This might even be against a patient’s wishes.

However, if a patient does not lay out their wishes in an Advance Directives, it might be difficult for their families to make a decision for them at a critical point when a decision has to be made in minutes or hours.

Beginning discussion early with our team of palliative professionals can provide much help to you and your family. We have June Cichowicz, our social worker on the palliative care team, to meet and discuss. June has a weekly class on Wednesdays that you may consider joining (see below).

Come and participate in a class for an improved journey while living with Cancer:

DATES
1st, 2nd, & 4th Wednesdays
TIME
1:30 – 2:30
LOCATION
Meetings held in Conference Room 446 – 4th floor Medical Office Building
710 Lawrence Expressway
Santa Clara, CA 95051
PHONE
June Cichowicz, LCSW  408-851-4305

You can also call Susan Tilton, our social worker in Medical Oncology. Susan also hosts a general cancer support group and a gynecologic cancer support group. Susan is very resourceful and helpful.

A recent article by Atul Gawande in “The New Yorker”, “Letting Go” would be interesting to read. Atul Gawande is a professor and surgeon at Harvard Medical School. In this article he discussed about palliative care using his experience with his father and his patients. He is a fluent writer, a keen observer and researcher in medical care. He has published several books on medical care. I have read all his books with interest.

We wish you all the best and live a long and happy, and most importantly, peaceful life.


Additional References and Lnks:

Destination health: Stopping cancer before it starts

Focus on cancer prevention, screening, treatment, and research

2019 "Eat Well, Heal Well Live Well" Resources and Educational Session Links

Resources and educational links for our 2019 Seeds of Hope.

2018 Healthy Body, Healthy Mind Resources and Educational Session Links

Resources and educational links for our 2018 Seeds of Hope.

View All »