When breast cancer is diagnosed the immediate focus, of course, concerns treatment, surgery, restoration, and future management. Supportive and Palliative Care however, may be useful at any stage of illness.
Palliative Care referral is often made late in an illness, after months or years of treatment, when symptoms such as pain are difficult to control. A referral to palliative care can be made at any time for patients with serious diseases such as advanced breast cancer. Difficult symptoms are easier to control if they are considered early; Community support, counselling and extra help for your carers are always beneficial at any time.
A palliative care team (usually a clinical nurse and doctor together) will, during a long consultation, gather your history and an understanding of your journey with cancer, determine what supports are available at home and in your community, and try to understand the thinking, emotions, and other psychological and spiritual aspects that will be important.
Palliative Care will give information on available community support and nursing services, and may refer to psychologists and counsellors who can provide extra emotional support to both patient and their carers. After an initial discussion, information and advice will be left, including follow up plans and phone contact information. Help in controlling difficult symptoms such as nausea, pain and fatigue will be discussed and treated if needed. We try to be very practical and useful at every contact as I know your time is precious. Possible future problems, fears and uncertainties can be discussed at the initial visit or addressed during future contacts. We will follow your wishes, and go at your speed, as every patient is unique with individual needs and concerns.
Palliative care does not prevent or interfere with your cancer treatment in any way. Knowing that relief of symptoms and distress, practical help with nursing, and getting support for partner, family and other carers is available now, or in the future if needed, can be comforting.
What is Palliative Care?
- uses your choices and wishes as guide to care, and can help you remain at home for as long as your carers are comfortable in providing care. Your wishes and choices concerning advance care planning, end of life issues, Advance Health Directives, “Living Wills” and surrogate decision making in future are respected, important and will be discussed.
- can start while you are still having treatment, with regular communication with your specialists, and GP.
- is provided by a closely linked team of specialised doctors, nurses, counsellors, occupational therapists and others to find freedom from pain, symptoms and distress.
- supports your carers. Counselling and bereavement support is usually available to everyone involved in the care of the patient.
- organises nursing at home if needed. Hospital beds, other equipment, visiting nurses and physiotherapists can be organised as is needed.
- addresses any problems and distressing symptoms that you may have such as pain. Problems may include loss of energy, anxiety, fears, depression, help needed with walking or showering and loss of appetite. Our goal in Palliative Care is to help patient remain as active as possible with maximal relief of any symptom that interferes with comfort.
How to find Supportive and Palliative care?
Your specialist, GP or nurse can refer you to a Palliative Care service in most parts of Australia. A palliative care referral can be made at any time in your illness.
Following a referral, Palliative Care will talk to the patient at clinic or at home to review the medical story, and to assess problems and care needs that are present or may arise in the future. Often a referral will be made to a home nursing service. Follow up plans for reviews are made according to the needs and wishes of the patient. Often a patient will have both cancer specialist and palliative care at the same time. One type of care does not exclude the other, as usually several forms of treatment and support is important for your maximum benefit.
Palliative Care is guided by patient’s needs and choices. Care needs may increase through the illness and increased support will be provided in home as needed. At times patient may need to be admitted to a palliative care ward in hospital, or hospice. Care is aimed totally towards support and relief of symptoms and distress.
Dr Richard Russell, from St Vincent’s Hospital