Understanding Palliative Care
Palliative care focuses on relieving symptoms and improving quality of life, and can be provided alongside active treatments like chemotherapy, immunotherapy, or surgery.
Palliative care is NOT the same as hospice care. You can receive palliative care while still pursuing curative treatment. It focuses on symptom relief and quality of life at any stage of illness.
Palliative Care vs. Hospice Care
| Aspect | Palliative Care | Hospice Care |
|---|---|---|
| When started | Any time after diagnosis | Life expectancy 6 months or less |
| Treatment goal | Symptom relief + active treatment | Comfort only, no curative treatment |
| Setting | Hospital, clinic, or home | Usually home or hospice facility |
| Duration | Throughout illness | End of life |
Both approaches prioritize comfort, dignity, and quality of life, but palliative care can accompany aggressive treatment.
Symptoms Addressed by Palliative Care
Respiratory Symptoms
Shortness of breath:
- Often the most distressing symptom
- Caused by tumor growth, pleural effusion, or reduced lung capacity
- Managed with medications, oxygen, positioning techniques
Pleural effusions (fluid buildup):
- Thoracentesis: Drains fluid for immediate relief
- Pleurodesis: Seals pleural space to prevent reaccumulation
- Indwelling catheter: Allows ongoing drainage at home
Pain Management
Mesothelioma pain is managed through multiple approaches:
- Medications: From over-the-counter to prescription opioids
- Nerve blocks: Targeted pain relief
- Low-dose radiation: Can shrink tumors causing pain
- Physical therapy: Maintain mobility and function
Other Symptoms
| Symptom | Management Approaches |
|---|---|
| Fatigue | Energy conservation, activity planning, nutrition support |
| Nausea | Anti-nausea medications, dietary modifications |
| Appetite loss | Nutritional counseling, appetite stimulants |
| Anxiety/Depression | Counseling, medication, support groups |
| Sleep problems | Sleep hygiene, medication when needed |
The Palliative Care Team
A comprehensive palliative care team may include:
- Palliative medicine physician: Leads care coordination
- Nurse practitioners: Day-to-day symptom management
- Social workers: Emotional support, practical assistance
- Chaplains: Spiritual care
- Pharmacists: Medication management
- Physical/Occupational therapists: Maintain function
- Dietitians: Nutritional support
When to Consider Palliative Care
Research shows patients who receive palliative care alongside standard treatment report better quality of life, have improved symptom control, experience less depression and anxiety, and may even have better survival outcomes.
- Report better quality of life
- Have improved symptom control
- May even have better survival outcomes
- Experience less depression and anxiety
Consider palliative care when:
- You’re diagnosed with mesothelioma (at any stage)
- Symptoms are affecting your quality of life
- Treatment side effects are difficult to manage
- You need help making treatment decisions
- You want comprehensive support for you and your family
Hospice Care
Hospice is appropriate when:
- Life expectancy is 6 months or less
- Curative treatments have been stopped
- The focus shifts to comfort and quality of remaining time
Hospice Eligibility Criteria
Patients typically qualify when experiencing:
- Rapid physical decline
- Severe symptoms reducing quality of life
- Choice to focus on comfort over aggressive treatment
- Disease progression despite treatment
Levels of Hospice Care
| Level | Description |
|---|---|
| Routine home care | Regular visits from hospice team |
| Continuous home care | 24-hour care during crisis periods |
| Inpatient care | Short-term facility care for symptom management |
| Respite care | Temporary relief for caregivers |
Hospice Services
For patients:
- Symptom management and pain control
- Emotional and spiritual support
- Assistance with daily activities
- 24/7 on-call nursing support
- Medical equipment and supplies
For families:
- Caregiver education and support
- Respite care (breaks for caregivers)
- Bereavement counseling
- Support groups
Procedures for Symptom Relief
Thoracentesis
Purpose: Drain pleural fluid causing shortness of breath
Process:
- Needle inserted through chest wall
- Fluid drained (often 1-2 liters)
- Outpatient procedure
- May need to be repeated
Pleurodesis
Purpose: Prevent fluid reaccumulation
Process:
- Talc or other agent inserted into pleural space
- Creates adhesion between lung and chest wall
- More permanent solution than thoracentesis
- Can be done via VATS (video-assisted thoracic surgery)
Indwelling Pleural Catheter
Purpose: Allow ongoing fluid drainage at home
Process:
- Small catheter placed in chest wall
- Patient or caregiver drains fluid as needed
- Avoids repeated hospital visits
- Good option for recurrent effusions
Quality of Life Considerations
Physical Well-Being
- Maintain activity as tolerated
- Conserve energy for important activities
- Accept help with tasks when needed
- Focus on what you can do, not limitations
Emotional Health
- Allow yourself to feel all emotions
- Seek counseling or support groups
- Stay connected with loved ones
- Consider spiritual support
Practical Matters
- Discuss advance directives
- Communicate wishes to family
- Address financial and legal concerns
- Accept practical help from others
Caregiver Support
Caregivers also need care:
- Respite services: Take breaks
- Support groups: Connect with others in similar situations
- Counseling: Process difficult emotions
- Practical assistance: Help with tasks, transportation, meals
Can I receive palliative care while continuing treatment?▼
Yes. Unlike hospice, palliative care can be integrated with active cancer treatment—chemotherapy, immunotherapy, even surgery. It focuses on symptom management and quality of life at any stage.
What symptoms can palliative care help manage?▼
Palliative care addresses shortness of breath, pain, pleural effusions (fluid buildup), fatigue, nausea, anxiety, depression, and sleep problems. The team coordinates multiple approaches for each symptom.
What support is available for my family?▼
Palliative care includes caregiver support: education, respite services, counseling, and practical assistance. When transitioning to hospice, bereavement counseling continues for 13 months.
When should I consider hospice care?▼
Hospice is appropriate when life expectancy is 6 months or less and the focus shifts from curative treatment to comfort care. Your medical team can help determine when this transition is appropriate.
Finding Palliative Care
- Your oncology team: Can refer you to palliative care
- Hospital palliative care services: Most cancer centers have programs
- Community hospice organizations: Many offer palliative care too
- Palliative Care Provider Directory: getpalliativecare.org
References
New England Journal of Medicine. (2010). Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer.
https://pubmed.ncbi.nlm.nih.gov/20818875/
Journal of Clinical Oncology. (2017). Integration of Palliative Care into Standard Oncology Care.
https://pubmed.ncbi.nlm.nih.gov/27069075/
Center to Advance Palliative Care. (2024). Get Palliative Care Provider Directory.
https://getpalliativecare.org/