Palliative Care in Cancer

The primary goal of cancer care is cure, which is achieved in more than half of patients. Nevertheless, the greatest use of resources will be for patients with disseminated cancer, as we now have a good chance of both prolonging life and providing a good quality of life.

The scenario has changed significantly over the last 20-30 years. Today, a disseminated and therefore a palliative situation means something different than in the past.

In many large diagnostic groups such as breast, prostate and colorectal cancer, distant spread usually means that the patient is no longer curable, although situations are emerging where modern cancer treatment can cure patients with a single metastasis, for example a single localised liver metastasis or brain metastasis. In other situations with disseminated cancer, modern treatment can help patients live for many years, with good quality of life.

The situation may be slightly different in haematology. Modern treatment is therefore important for the patient. At the same time, we know from very recent studies that if palliative interventions are initiated early in the palliative course, they lead both to an increased quality of life and even to some prolongation of life.

The palliative approach

According to the WHO (World Health Organisation) in abridged version (2002), the palliative approach is based on a holistic approach with:

Four dimensions

• The physical, which includes, for example, pain, shortness of breath, nausea, itching, cancerous ulcers and constipation
• The psychological, which includes depression, anxiety, sleep and confusion
• Social, such as relationships, relatives, housing, finances and problems of family members
• Existential, such as fear of death, guilt, meaninglessness and unresolved relationships

Four cornerstones

• Symptom control
• Support for relatives
• Communication/relationship
• Teamwork

The palliative approach is well applicable

• In earlier stages, early phase, aiming at life prolongation and quality of life
• In later stages, late phase, aiming at quality of life but not prolongation of life

National palliative care guidelines

There are two national palliative care guidelines - one for adults (patients aged 18 and over) and one for children (patients aged under 18). They describe how palliative care should be provided, regardless of the patient's diagnosis, background, ethnicity or type of care. They describe the whole palliative care pathway, from the early phase to the late phase.

National Working Group for Palliative Care

The national working group for palliative care within the Regional Cancer Centres (RCC) consists of physicians and nurses who are all involved in clinical knowledge management of palliative care both on a national and a regional level.

E-learning education

Starting 2021 the working group decided to focus on developing and creating e-learning education in palliative care. A collaboration was initiated between the Confederation of Regional Cancer Centres and a nonprofit healthcare foundation called Betaniastiftelsen. Based on Betaniastiftelsens basic education in palliative care which the working group helped revise, the overall aim is to create specific modules for clinical staff who meet patients in need of palliative care. These modules are complements to the basic training program and will help clinical staff achieve more advanced skills in palliative care.