For Your Patients: Palliative Care

No two patients with melanoma are exactly alike. The lesions might be similar with respect to size, location, and characteristics, and patients might be the same age or sex and have similar types of skin. But the way a patient experiences melanoma, and responds to the experience, is unique. A specialized area of healthcare has evolved to meet the unique needs of each patient during the journey through melanoma -- or another type of cancer or serious condition. The term palliative care refers to a broad array of treatment and services that extend far beyond cancer therapy to address the specific problems, issues, and needs of each patient.

The National Cancer Institute describes palliative care as "an approach to care that addresses the person as a whole, not just their disease. The goal is to prevent or treat, as early as possible, the symptoms and side effects of the disease and its treatment, in addition to any related psychological, social, and spiritual problems." Palliative care includes services and support for family members and caregivers, in addition to patients.

The American Society of Clinical Oncology and the National Comprehensive Cancer Network recommend that patients with cancer have a palliative care assessment soon after diagnosis, with follow-up assessments at regular intervals. Multiple studies have shown that palliative care, in addition to cancer treatment, leads to better quality of life and, in some cases, better cancer outcomes.

The key to effective palliative care is communication between the patient (as well as the family and caregivers) and the oncologist and other healthcare providers. An assessment initially might focus on identifying and managing symptoms and side effects of the cancer and its treatment. However, following the concept of treating the "whole person," an assessment can extend to a wide range of issues affecting you, your family, or caregivers: depression, stress, work-related problems or concerns, child care, financial concerns, transportation issue, and sexual function -- and many others.

If an assessment does not cover an issue that matters to you, take the initiative to bring it up. Providers may identify some, but not all, of your concerns, so it's important to tell them about any challenges you may be experiencing. Palliative care can occur at the same time as the treatment for melanoma, and assistance and support can continue after cancer treatment has ended.

Patients with advanced melanoma in particular should have honest discussions with providers about their symptoms and general wellbeing because this can be very impactful on treatment planning. Patients who are spending more time in bed or resting than participating in day-to-day activities should express this to their providers so they can have conversations about changing or stopping treatment. A patient's personal goals and wishes are always the first consideration for more treatment.

Palliative care can also be a helpful team to guide you and your family to prepare for a time where decision-making may be challenging. The team can assist with discussions on giving a family member or other person power of attorney for healthcare decisions should you become unable to make the decisions, and can involve religious and spiritual advisers as requested. The palliative care team can also help with important discussions on code status and whether a patient would want aggressive life-saving measures performed in the event of an emergency.

End-of-Life Care

No patient with melanoma wants to think about bad outcomes, but the fact remains that some melanomas are diagnosed at late stages or recur and spread to other sites in the body. In such cases, an oncologist might determine that continuing treatment is not worthwhile. The decision to stop cancer treatment ultimately rests with the patient and/or family and caregivers.

When cancer treatment ends, palliative care continues, with the goal of making the patient as comfortable as possible in the setting (increasingly, at home, with friends and family) that is most consistent with the patient's wishes and the best place to manage their symptoms. Palliative care specialists can help achieve those goals through their involvement in planning care and support and identifying resources to continue meeting patient/family/caregiver needs.

Read previous installments in this series:

For Your Patients: What Is Melanoma?

For Your Patients: Is What You're Seeing Harmless or Is It Melanoma?

For Your Patients: Is It Melanoma or Something Else?

For Your Patients: What to Know about Treating Early-Stage Melanoma

For Your Patients: New Options, Better Outcomes for Advanced Melanoma

For Your Patients: Choosing the Right Therapy for Advanced Melanoma

For Your Patients: Managing Recurrent Melanoma

For Your Patients: Follow-Up Care for Melanoma

"Medical Journeys" is a set of clinical resources reviewed by doctors, meant for physicians and other healthcare professionals as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.