Palliative care

The World Palliation Day falls on October 7th every year , a day when Palliative care is celebrated.

What is palliative care ?
It is the active total care of a patient suffering from an incurable condition. Cancer patients form a large chunk in this group though others like HIV positive people,paraplegics ,Alzheimers disease patients also need palliative care. Oncology the medical specialty of Cancer .has made great strides today with the advent of targeted therapy in medical oncology, high tech oncosurgery, and state of the art radiotherapy and many cancer patients have greater chances of a cure today than a decade ago. But in some cases where the tumor is more aggressive ,more advanced or those with delayed diagnosis or inadequate treatment ,it is not curable. This does not mean it is the end of the road and the patient has to be provided relief using all means possible. It is the right of every human being to have access to such care palliation offers a beacon of hope in this situation of no cure.

Can one provide comfort even when there is no cure ?
This emphasis on healing is what palliative care is all about even when there is no curing. A commonly prevalent myth is that palliative care is terminal care. Palliation is just not terminal care but a composite care of the cancer patient where all modalities of treatment like chemotherapy ,radiotherapy ,surgical oncology, and scientific pain management is used as required to comfort the patient at any stage .None can be denied the benefits accrued from all these types of treatment. It is also the holistic care of the patient using tenets of psychology and taking into consideration his social ,spiritual ,and cultural needs. Pain the most dreaded of all symptoms is managed using opioids like morphine and analgesics used judiciously by trained doctors. Cancer creates deep alienation of the patient who feels isolated and palliative medicine tries to extricate him from this self imposed ghetto and provides him a positive outlook to his remaining life. Listening to the paitent with patience is given utmost importance in palliative care. Here the doctor and the paramedical personnel are part of a team which includes the patient,his family and friends to provide hope and succor and to relieve him of physical symptoms to the extent possible .It also tries to address the needs faced by the family in their predicament .A supportive framework for the family is provided by giving them a respite from their misfortune and sharing their problem. Terminal care is also an important need which comes under palliation ,a comfortable painless death is a right for every human being and no one should be denied this. When death becomes inevitable one could at least face it in comfort. Hospices address this problem to a certain extent. Home care services too are an important link in palliative care where the team visits patients in their houses .The role of health professionals and volunteers from society is very great for greater community reach . Kerala has excelled itself in this aspect of health care having more than eighty palliative units with active community participation .compared to this several states in North India do not even have a single such unit. The Lakeshore pain and palliation unit a part of the medical oncology department has existed for the past two years and has provided relief to the needy. It has the added advantage of the support of a team of eminent professionals in the field of medical oncology and a state of the art hospital to provide the needed succor ,at the same time its entire outlook in palliative care is low tech and high touch .More than five hundred patients have received oral morphine and other drugs to combat their pain and many of them continue to be active while being pain free . Morphine as commonly thought does not cause sedation or addiction if used correctly in chronic cancer pain .It is a cheap oral analgesic and has been found to be the most effective for such situations .  A verse in the holy Quran says " may you be wrapped in tenderness my brother as if in a cloak " in Latin cloak is Pallium and palliation is derived from this term. It is a welcome fact that more palliative units are sprouting in Kerala today and it is essential that the public and the government are aware of its significance to cancer patients and support it wholeheartedly. Let us look forwards to a world free of pain and other discomforts and a peaceful continuation of life and also a comfortable death to those for whom it is inevitable and unavoidable in the near future .

Dr.N.Harimohan MBBS ,DMRT ,CCPPM .
Palliative care unit
Lakeshore hospital and research center