There’s nothing more terrible than receiving news of lung cancer. In most cases, this is the equivalent of a death sentence and the only questions are how to manage the pain as death approaches and what quality of life can be preserved. All too often, the pain becomes unmanageable and there’s death without dignity. However, as pain management clinics establish new approaches to palliative care, we are beginning to see real progress in preserving quality of life. Just to clarify the aim of palliative care, it’s intended to reduce the worst of the symptoms. This is essential when you know you can’t actually stop or even delay the progress of the disease itself. In every sense, this is a team effort involving doctors, nurses, psychologists, counselors, therapists and, where the patient is religious, representatives of the relevant faiths. All these trained professional focus not just on the patient, but also on the families and, where appropriate, the friends. The intention is to produce an emotionally secure environment in which the patients can live out their final period of life. A new study at the Massachusetts General Hospital studied the outcomes of patients over a three year period.
The first point of interest lies in the timing of the diagnosis. If the patient discovers the disease at the earliest possible point in its development, it gives the palliative care team the maximum time to counsel and support the patient and family. This allows the individual patient to get over the shock and reach an emotional accommodation with the disease before it progresses too far. If, for some reason, the diagnosis is delayed, patients are still dealing with the shock factor as their condition starts to worsen. This tends to make the patient’s reaction to the disease less rational. More importantly, people who were diagnosed earlier and received counseling lived longer and had a better quality of life. Patients who come to palliative care later in the progress of the disease are more likely to insist on aggressive treatment in the hope of prolonging life even though the doctors advise such efforts are almost certainly going to be ineffective.
The study also shows the patients receiving care were less depressed and so able to live out their lives without relying on antidepressants. Even more interestingly, they were able to manage their pain using Tramadol for longer. Although everyone moves up to the more powerful narcotic painkillers as the disease moves into its final phase, patients actually felt better in themselves with less medication.
There’s a real lesson to be learned from this. Patients who are treated as human beings with needs, tend to do better under managed care than those who are stuffed full of painkillers and left to die. Although palliative care uses more labor and is therefore more expensive than traditional healthcare models, it clearly produces better outcomes with Tramadol and other drugs producing fewer adverse side effects. The researchers conclude this interdisciplinary approach should be extended to all diseases across all hospital and clinics.