When diagnosis is cancer, palliative care is good therapy

July 1, 2005

Palliative care is different from hospice care because it may be offered at any stage of an advanced illness. Hospice focuses on comfort care when a cure is no longer possible.

Dermatology patients facing a diagnosis of cancer have traditionally found surgery, chemotherapy and radiation and, more recently, immunotherapy, as the core options for managing their disease. But more often, dermatologists are including supportive and palliative care in the arsenal of therapies.

"It's important for newly diagnosed cancer patients, patients undergoing cancer treatment, cancer survivors and patients whose disease is no longer curable," Dr. Ugurel says. "Too many cancer patients with pain, depression and fatigue receive inadequate treatment for their symptoms." Palliative care is different from hospice care because it may be offered at any stage of an advanced illness. Hospice focuses on comfort care when a cure is no longer possible.

For instance, the treatment of cancer-related anemia, which is the decrease in the amount of hemoglobin in the peripheral blood, can occur from cancer surgery, radiotherapy, chemotherapy or immunotherapy. All of these therapies can cause patients with cancer to experience fatigue, headache, shortness of breath and depression. A recent study including 4,382 patients from two open-label, non-randomized multicenter trials found that changes in hemoglobin levels were linked to quality of life during chemotherapy in anemic cancer patients receiving erythropoietin (epoetin alpha) therapy.

Some 23 randomized controlled trials have compared epoetin to observation/control in cancer patients receiving chemotherapy. Overwhelmingly, epoetin has been found to be a safe and effective treatment option to reduce treatment-related anemia, the need for red blood cell transfusion and in patients with a slow decline in hemoglobin and associated fatigue.

Pearls Dr. Ugurel offers these suggestions to help patients with cancer receive adequate treatment for their pain, depression and fatigue:

1) Clinicians should use brief assessment tools routinely to ask their patients about pain, depression and fatigue and initiate evidence-based treatments;

2) All patients with cancer should have optimal symptom control from diagnosis through the course of illness, irrespective of personal and cultural characteristics;

3) The state of the science in cancer symptom management should be reassessed periodically.

When it comes to end-of-life care, special considerations need to be taken. The European Society for Medical Oncology (ESMO) has developed core principles for patients whose disease is no longer curable. They include:

"Cancer patients receiving active therapy in cancer centers should routinely be assessed for the presence of severity of physical and psychological symptoms and for the adequacy of social supports," Dr. Ugurel says. "When inadequately controlled symptoms are identified, they must be evaluated and treated with the appropriate urgency."