The term “palliative” is used by physicians in the care of patients when the disease can no longer be expected to be cured. This is the case, for example, when a cancerous tumor can no longer be completely removed and many metastases are present.
However, this does not necessarily mean that death is imminent for patients receiving palliative care. Despite an incurable disease, a patient may well live to a ripe old age. Palliative therapy is therefore not always limited to the last phase of life, but can begin at earlier stages of the disease.
Palliative care – adapted to the needs of the individual patient – can be provided on an inpatient basis (in a hospital, for example) or on an outpatient basis.
Goals of palliative treatments
The focus of palliative care is the individual. Doing everything possible to ensure that he or she can make the most of the remaining time of life is the priority. Prolonging life is therefore not the primary goal.
Other goals of palliative treatment besides quality of life and independence may include:
- Preservation of vital organ functions (for example, in the case of intestinal obstruction caused by the tumor)
- @ Avoidance of life-threatening complications (e.g. respiratory distress)
- Reduction of metastases
- Relief of pain or other symptoms such as cough, nausea, vomiting, confusion, restlessness
- Treatment of depression, fear of death or the dying process
- Wound care
Medical palliative treatments
Palliative care uses procedures that are also curative, that is, used to heal. Each of these measures puts a strain on the body and is usually accompanied by side effects (e.g. chemotherapy for cancer with headaches, nausea, vomiting, hair loss, etc.). The benefits and side effects of treatment must be weighed against each other in each individual case.
Palliative surgery
Palliative surgery is not directed against the cause of the disease, but is intended to prevent complications. For example, it may aim to remove a growing tumor that is blocking the function of a vital organ. For example, if a tumor causes an intestinal obstruction, an artificial anus (anus praeter) must be placed.
Every operation is itself associated with a risk. This must be weighed up in advance when deciding for or against palliative surgery. For example, advanced age, poor general health or nutritional status may militate against surgery.
Palliative radiation
Palliative radiation (palliative radiotherapy) is intended to fight cancer metastases or shrink a tumor. Examples:
Bone metastases, common in breast, prostate, and lung cancer, spread through the bone and are associated with severe pain and risk of bone fractures (breaks). If they are irradiated, this can relieve the patient’s discomfort and increase bone strength.
If a tumor presses on the trachea or the superior vena cava (for example, in the case of lung cancer), shortness of breath, a feeling of suffocation and/or a congested backflow of blood to the heart are the result. Radiation can help in these cases as well.
Metastases in the brain can result in a loss of brain function, causing neurological symptoms such as blindness, paralysis or convulsions. Since brain metastases often occur in clusters rather than singly, whole-brain irradiation is useful in this case. However, targeted individual brain metastases can also be irradiated.
Palliative chemotherapy
The basis of palliative chemotherapy are so-called cytostatics – special drugs that are directed against fast-growing cells (such as cancer cells). Administered intravenously, they can act throughout the body (systemically). The effect of chemotherapy can be enhanced by combining different cytostatic drugs.
Palliative antibody therapy
Palliative antibody therapies have been available in addition to chemotherapy for several years. This involves the use of special, artificially produced antibodies that specifically target the cancer.
For example, some of these antibodies can block the docking sites (receptors) of messenger substances on the surface of the cancer cells that mediate growth signals – tumor growth is inhibited. Other therapeutic antibodies block the formation of new blood vessels that the tumor needs for its supply.
Medicinal pain therapy
Palliative medicinal pain therapy can significantly improve the quality of life of seriously ill people. Various groups of drugs are available as analgesics.
In many countries, doctors are allowed to use cannabis or cannabis-containing medicines for pain therapy in certain cases, for example in Germany, Austria and Switzerland. The exact regulations vary from country to country, for example in which form medicinal cannabis may be used (e.g. only cannabis-containing medicines or, for example, also dried cannabis flowers) and in which cases (e.g. tumor pain).
Other treatment methods such as acupuncture and physiotherapy can complement pain therapy.
Other medicinal palliative treatments.
In addition to pain, many other complaints of seriously ill people can be treated with medication – for example, nausea, constipation, loss of appetite, increased intracranial pressure, respiratory distress, depression, anxiety, restlessness and panic.
What else helps
Many symptoms such as pain, tension or shortness of breath can be reduced with proper physical therapy. These include:
- Classical physiotherapy
- Respiratory therapy
- Exercise bath
- Complex physical decongestive therapy
- Transcutaneous electrical nerve stimulation (TENS), stimulation current
- Colon, connective tissue, foot reflexology and classical massage
- Fango, hot air, red light
Both the terminally ill person himself and his relatives can benefit from palliative psychotherapy. Suitable psychological therapy methods may include:
- Talk therapy
- Crisis intervention
- Stress reduction
- Psychoeducation through education and training
- Relaxation techniques
- Art, creative, design therapy
Many affected persons and/or their relatives also benefit from the exchange in a self-help group.
Nutrition therapy also plays a major role. During a severe illness and its treatment, many affected persons struggle with symptoms such as loss of appetite, nausea and vomiting. Often, accompanying symptoms such as inflammation of the oral mucosa or taste and swallowing disorders also make it difficult to eat. Weight loss is then the consequence. Particularly in the case of severe illnesses, however, the body is dependent on a good supply of nutrients.
If possible, an attempt is made to achieve this through normal eating and drinking. The following recommendations generally apply to such an oral diet:
- whole foods rich in vitamins, fresh foods, plenty of fluids
- avoidance of alcohol, coffee, fatty foods
- no diet: sufficient protein and fat!
- several small meals spread throughout the day
- appealing presentation
However, some patients require artificial feeding. Here, a distinction is made between two forms:
- enteral nutrition: supply of nutrients via a feeding tube (stomach tube), intestinal function is maintained
- parenteral nutrition: supply of nutrients bypassing the digestive tract, i.e. directly via infusions into a vein
In the last phase of life, artificial nutrition is rarely indicated. In most cases, it is part of the dying process if the dying person refuses to eat.
