What do you mean by “Palliative” or Supportive Care?

[CindyA]

What do you mean by “Palliative” or Supportive Care? Is that Code for “We’re Giving Up on You?”

July 12th, 2013 - by Dr. Jack West

One of the first questions that is often addressed when someone is diagnosed with cancer is whether the treatment is with curative or palliative intent. Palliative care can mean many things, and some health care professionals use it simply to mean that a treatment is given for a reason other than an expectation of being able to completely cure a patient. Treatment that can prolong survival for months or years but not cure it is absolutely valuable but may still be palliative.

It’s important to distinguish this from another use of palliative care as terminal care. Palliative care is sometimes loosely applied to the situation of treating symptoms for a patient who may be dying. Similarly, supportive care may just refer to addressing symptom management and quality of life alongside efforts to prolong survival, or even deliver a cure, or it is sometimes a term used to define the efforts to maximize quality of life at the end of life.

None of this means that a person receiving palliative or supportive care is being given up on. First, palliative care or supportive care are not consolation prizes for aggressive care. As I noted, sometimes life-prolonging treatments are still palliative, and supportive care/management of symptoms isn’t mutually exclusive with prolonging survival or treating for cure. But even for patients who don’t have treatment options that can feasibly prolong survival, managing symptoms and quality of life may be the most beneficial treatment that can realistically be suggested, and overly aggressive treatments with little or no realistic probability of prolonging survival have a significant probability of shortening survival.

Cancer care needs to be an appropriate balance between under-treatment and over-treatment. That care may be palliative, may be supportive, but these terms don’t mean that it’s not valuable and effective treatment.

Have these terms led to confusion for you? I’d like to hear.

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