Building a Simple Way of Knowledge in Palliative Care

¹Clinical Oncology Unit, Istituto Neurotraumatologico Italiano (I.N.I) Grottaferrata (Rome), Italy

²Palliative Care Center “S. Antonio da Padova”, Rome, Italy

*Corresponding Author:

Dr. Antonio Rozzi
Clinical Oncology Unit, I.N.I. Grottaferrata
via di S.Annasnc 00046 Grottaferrata (Rome), Italy
E-mail: antoniorozzi@virgilio.it

Received date: January 03, 2012; Accepted date: January 04, 2012; Published date: January 10, 2012

Citation: Rozzi A, Salerno M (2012) Building a Simple Way of Knowledge in Palliative Care. J Palliative Care Med 2:e110. doi:10.4172/2165-7386.1000e110

Copyright: © 2013 Jung YG. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

The dramatic advances in clinical therapy and nutrition have produced a progressive increase in life expectancy. Due to the ageing of population, a growing proportion of persons may develop, during their life-time, progressive chronic illnesses (cancer, cardiovascular diseases, dementia, debilitating arthritis, infective diseases) with a consequential greater need for social and economic support. Palliative care recognizes the responsibility of attending to the needs of these patients with their families. Physicians involved in palliative care should relieve pain and the other symptoms: they have expertise in symptoms management and in the communication skills to improve discussion with patients and their families about treatment possibilities, preferences and goals of care. Palliative care focuses primarily in diagnosing and treating symptoms experienced by patients with progressive incurable diseases. The ultimate goal of palliative careis to improve quality of life for both the patient and the family, regardless of diagnosis. Moreover, palliative care reduces the need of hospitalization, diagnostic and treatment interventions and nonbeneficial intensive care [1]. The mandatory aim of palliative care is the relief of the “total pain” of a dying person and his family. What is the “total pain”? As firstly described by Cecily Saunders, total pain is the sum of patient’s physical, psychological, social and spiritual pain.

The dramatic advances in clinical therapy and nutrition have produced a progressive increase in life expectancy. Due to the ageing of population, a growing proportion of persons may develop, during their life-time, progressive chronic illnesses (cancer, cardiovascular diseases, dementia, debilitating arthritis, infective diseases) with a consequential greater need for social and economic support. Palliative care recognizes the responsibility of attending to the needs of these patients with their families.

Physicians involved in palliative care should relieve pain and the other symptoms: they have expertise in symptoms management and in the communication skills to improve discussion with patients and their families about treatment possibilities, preferences and goals of care.

Palliative care focuses primarily in diagnosing and treating symptoms experienced by patients with progressive incurable diseases. The ultimate goal of palliative care is to improve quality of life for both the patient and the family, regardless of diagnosis.

Moreover, palliative care reduces the need of hospitalization, diagnostic and treatment interventions and nonbeneficial intensive care [1].

The mandatory aim of palliative care is the relief of the “total pain” of a dying person and his family. What is the “total pain”? As firstly described by Cecily Saunders, total pain is the sum of patient’s physical, psychological, social and spiritual pain [2].

Despite the efforts in cure cancer and other chronic and progressive diseases, when the cure is not longer the goal, many questions and needs remain unresolved.

Are symptoms systematically assessed and treated? Are decisionmaking processes supported and displayed in this medical field? Which kind of real and practical aid is offered to patients and their families?

Unfortunately, many differences in care intensity and care quality exist worldwide: a dramatic disparity in terms of access to palliative care is present in different areas of the same country and much more disparity exists between developed and developing countries. Could the financial crisis negatively impact such disparities? Probably, yes. In a recent report from the Economist Intelligent Unit case fatality from cancer was 46% in high-income countries compared with 75% in lowincome countries [3].

During the past decade, substantial progress has been made in developing strategies and interventions for improving symptom management.

Despite this, pain remains one of the most feared symptoms and it still represents a major problem: in a recent systematic review pain was reported in 59% of cancer patients with metastatic/terminal disease [4].

The impact of undertreated pain can negatively influence physical functioning, psychological well-being and social interactions [5].

In a pan-European survey 69% of cancer patients reported painrelated difficulties with daily activities [6].

Recently, WHO estimated that over 80% of world’s population is inadequately treated for moderate and severe pain [7].

Palliative care should relieve physical symptoms, alleviate depressive symptoms and family’s burden: as recent papers have reported, a well planned and integrated intervention could positively affect both quality and duration of life in terminally-ill cancer patients [8-10]. Such data should drive our forward-looking agenda: rapid solutions are needed and many answers are possible.

For example, an exciting challenge for the future should be the global improvement of knowledge in medicine. This mission will be achieved if every new scientific finding will be available for all without significant costs: consequently, internet is a real worldwide possibility and opportunity and open-access journals could help this process of knowledge.

Such use of technology could promote general awareness of the medical advances: this aspect seems to be of particular interest in palliative care, an interdisciplinary area that still presents several criticisms in terms of care standardization all over the world.

Journal of Palliative Care & Medicine is an open access journal that promotes progress in knowledge in palliative care and allows people in the medical community and patients to know the latest advances and findings in this field.

References

1. Meier DE, Brawley OW (2011) Palliative Care and the Quality of Life. J Clin Oncol 29: 2750-2752.
2. Saunders C (1996) A personal therapeutic journey. BMJ 313: 1599-1601.
3. http://livestrongblog.org/GlobalEconomicImpact.pdf
4. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, et al. (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18: 1437-1449.
5. Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS (1995) When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 61: 277-284.
6. Breivik H, Cherny N, Collett B, de Conno F, Filbert M, et al. (2009) Cancerrelated pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20: 1420-1433.
7. www.who.int/entity/medicines/areas/quality_safety/ACMP_Biennial_Report_ 2006-07_EN.pdf
8. Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, et al. (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the project ENABLE II randomized controlled trial. JAMA 302: 741-749.
9. Giese-Davis J, Collie K, Rancourt KM, Neri E, Kraemer HC, et al. (2011) Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis. J Clin Oncol 29: 413-420.
10. Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki k (2007) Comparing hospice and nonhospice patient survival among patients who die within a threeyear window. J Pain Symptom Manage 33: 238-246.