Understanding Palliative Care, with Kavitha Ramchandran, MD

March 8, 2016
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Palliative care focuses on preventing, managing, and relieving the symptoms of cancer and the side effects of cancer treatment. In this podcast, Dr. Kavitha Ramchandran discusses the basics of palliative care, including when a person with cancer should consider palliative care and the role of a multidisciplinary palliative care team. 



ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors that care for people with cancer.

Palliative care focuses on preventing, managing, and relieving the symptoms of cancer and the side effects of cancer treatment. In this podcast, Dr. Kavitha Ramchandran discusses the basics of palliative care, including when a person with cancer should consider palliative care and the role of a multidisciplinary palliative care team. Dr. Ramchandran is a clinical Assistant Professor of Medicine in the Division of Oncology and the Division of General Medical Disciplines at Stanford University. She is also the Cancer.Net Associate Editor for Palliative Care. ASCO would like to thank Dr. Ramchandran for discussing this topic.

Dr. Ramchandran: Hi, my name is Kavitha Ramchandran, and I'm a physician at Stanford University in oncology and palliative care. It's my pleasure to talk to you a little bit today about palliative care and how it can best work with cancer care to provide a really good, integrated approach to the best help possible for patients and families who are undergoing cancer treatment and are going through the survivorship and end-of-life phases during their treatment. A lot of people don't actually know what palliative care means, and that's completely normal. A lot of times when patients come into my office, the first few minutes are really spent in talking about who we are, what our clinic comprises of, who are the members of my team, and how we work with your cancer care professionals, such as your medical oncologist, your radiation oncologist, or your surgical oncologist.

At its simplest, palliative care is a quality-of-life service. It is a multidisciplinary group of professionals that looks and feels a little different from other medical teams. It often includes a child life specialist, a chaplain, a nurse, a physician, a social worker. And that group, together, really spends time with patients and their families and their children to understand what their goals are in the context of their health care - how their health has been defined and impacted by their cancer both physically, socially, emotionally, and spiritually - and thinking about how we can make a plan of care that addresses all of those needs and allows for good goal-alignment so that the health care meets their life goals as they go through the process of their treatment.

When we think about when to integrate palliative care into cancer care, I would say that there is no right time for everyone, but it's never too early to start. So when you're thinking about a new diagnosis, or you're challenged by decision making, or you're worried about how you're feeling, or you're confronting difficult symptoms, or if you have a loved one who's really struggling with your illness, having a palliative care professional alongside your treatment could really shed some understanding and an additional source of support to try to make all of those pieces easier and to help create a clear road map in an often complex care plan in your health care. And so it's never too early, and it's very reasonable to think about adding a palliative care into your cancer care team when you're diagnosed and when you're initially dealing with your cancer diagnosis.

Palliative care can actually be practiced by a variety of professionals. There are people out there who have specialized training in palliative care, and they go through fellowships - much like your medical oncologists went through a medical oncology fellowship - and those are considered palliative care specialists. They're often found in the community and in academic medical centers and come from all walks of life. Some of them are medical oncologists themselves, others are family medicine doctors, others are internal medicine doctors. The real, additional training allows for them to have an expertise in symptom management, as well as in decision-making support for patients and families.

But oncologists themselves also provide palliative care and do so in a variety of different ways. When they provide supportive care medications for people who are going through chemotherapies - such as Zofran or Compazine - that's one component of palliative care. When oncologists are thinking through what the next best step in decision-making around chemotherapy is - in the context of changes and how you're feeling, physically - that's also another component of palliative care.

Oncologists integrate palliative care into their normal processes to make sure that your quality of life is as good as possible and that patients and families are able to fulfill their goals as they go through treatment. When we think about palliative care and if it's the right fit - and if you feel like it's doing the right thing for you, in terms of your health - it means that you have a team approach to care. That you feel like your palliative care specialist and your oncologist are working together. They understand what your goals are. They're communicating to provide a single care plan and that you have someone advocating for you who understands both the disease trajectory and the medical parts of your care. But also your life trajectory and how you want to achieve your short and long-term goals in the context of having an illness that's changed your life.

When you're in a clinical setting and you're thinking about palliative care, don't be afraid to talk to your doctor about whether palliative care is right for you. Often, some questions might be, "Do you have any colleagues who practice palliative care at this particular health care center or in the community?" Or, "I feel like I might need additional support for myself because of symptoms." Or, "I have a loved one who would merit from additional support as well, and I think a palliative care team would be helpful." I think, starting with just asking is a good place, and more often than not you'll find that your medical team is going to be highly supportive of you engaging with a palliative care provider as an additional part of your health care your team. I hope this is helpful and gives you a little bit of an understanding of how palliative care can work with you and your family to improve your health care overall and look forward to providing more information to you in the weeks and months to come.

ASCO: Thank you, Dr. Ramchamdran. To learn more about palliative care, visit www.cancer.net/palliative. And for more expert interviews and stories from people living with cancer, visit the cancer.Net blog at www.cancer.net/blog.

Cancer.Net is supported by the Conquer Cancer Foundation, which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high quality cancer care. Thank you for listening to this Cancer.Net podcast.