Palliative Care May Trump Heroic Measures in Life Expectancy

http://www.miller-mccune.com/health/hospice-may-trump-heroic-measures-in-life-expectancy-21098/

Health
August 18, 2010

Palliative Care May Trump Heroic Measures in Life Expectancy
A new study finds palliative care doesn’t put patients out of their misery; it puts the misery out of the patients.

By Joanne Kenen


The death panels, of course, don’t exist; they were the product of overheated political imaginations amid an overheated debate about health care reform. But palliative care does exist — and despite the distortions of last summer’s debate, it doesn’t mean “pulling the plug on Grandma.” (Or Grandpa for that matter, although he seems to have been neglected in the national brouhaha about death panels.)

A study published this week in the New England Journal of Medicine found that palliative care — which includes talking to patients and families about treatment goals and end-of-life wishes — doesn’t hasten death. To the contrary, the study of terminally ill lung cancer patients found that early access to palliative care prolonged life — even though the patients opted for less aggressive care as they neared death.

Researchers compared two similar sets of patients at Massachusetts General Hospital with advanced metastatic non-small cell lung cancer — the lethal and fast-moving form of the disease. Both groups got standard cancer treatment, consisting of chemotherapy and/or radiation. But one group also got early and ongoing palliative care. By several standard measures, the palliative care group had a better quality of life at 12 weeks and was less depressed. In other words, palliative care didn’t put the patients out of their misery. It took at least some of the misery out of the patients.

snip

when our son was in for his routine 6-wk long hospital trip ..We had to walk down that corridor to get to the play room, and there was little Amy's room at the very end of the hall.. her Mom was with her all the time, and we often wandered in to visit them.. That little girl was always asking her Mom.."Am I gonna die?"...and of course Mom would distract her and say.."Of course not..you are getting better every day".. She had a particularly vicious brain tumor and they could not operate again.

When she and our son (then 6) were playing together, she would tell him she was "gonna die"..

My son asked me if I though HE should "tell her Mom" because the doctors might be lying to Mom..:(

When we left that last time we saw her, she was hanging in there, but when we came back the next time, we asked the nurses about her & they said she had died a few weeks after we left.

telling them they are dying when they know they are dying. It's not just the parents protecting the child. It goes both ways. It sounds horrible. But, sometimes it really seems to work out for the best this way. It is an expression of love. It's hard to explain. But, there are other families who are comfortable with open communication and discussing death and final wishes. I have found it's best not to push it if that's not what the family wants to do.

And not lumps of flesh.... What a concept.

L-

because the doctor thought they were getting too much, even though they were screaming in pain...one is my wife, who had both knees replaced. She has been on high doses of pain meds for over a decade due to bone disease, and she has a high tolerance...she was prescribed a dose that would make me unconscious, but barely touched her pain...despite her medication records and notes from her family doctor, the post-op doc REFUSED to give her more because he thought she was getting enough.
I raised some shit with him and he changed his mind, but I am aware of many similar situations -even people who are dieing are refuesed pain meds because the doc thinks it's wrong...

doctor, I hope the same comes to you when you need it most.

mark

Typical attitudes here about 'sucking it up,' and avoiding treatment for pain are dead wrong. We do now know that pain untreated for too long can progress into generalized pain disorders to the point that even after the cause of the pain has been removed, the pain will persist.

Most doctors learn about treating short term, acute pain and have no idea that chronic pain is a different condition requiring a different approach. IMO, the war on drugs has had a lot to do with our reluctance to treat pain adequately. While practicing as an RN in Hospice, I had patients' physicians remark, on more than a few occasions, about a patient's 'drug seeking.' My response was always that I found most drug seeking stopped once I had the patient on a dose sufficient to control their pain.

passive torture
it is a crime against humanity in my opinion

People just eat up that religious bullshit.

My father was dying of lung cancer and refused the pain killers the Hospice folks provided. He suffered for it.

One thing I came to believe during my years working in oncology is there does come a point for many where we have ceased prolonging their life and have moved into prolonging their death.

Thank you for that. I've no experience in this, but what you say makes soooooooo much sense.