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Cancer "Moonshot" Should Include Palliative Care

06/20/2016

Vice President Joe Biden’s recent announcement of a “moonshot” campaign to find cures for cancer has raised awareness and inspired hope for new solutions to one of the greatest barriers to human health and longevity. “Not since the late President Nixon’s declaration of War on Cancer has so much focus been directed toward the experiences of the 1.66 million persons diagnosed with cancer annually in the United States,” write Dr. Arif Kamal and co-authors of an article featured in The Journal of the American Medical Association. Yet, even as America invests billions in seeking the cure for cancer, these authors argue that it is vital that we as a nation pay attention to the role of palliative care, which increases quality of life and has also been shown to reduce mortality.

It’s no accident that the new effort to find a cure for cancer is being described in terms that point back to the technological triumphs of the 1960s, when the United States succeeded in putting a man on the moon. The overwhelming focus of cancer medicine is on a technical fix that will do away with cancer once and for all. This goal, while admirable and worth fighting for, should not obscure the need for serious movement on palliative care as a solution for improving quality of life at the end of life, whether due to cancer or any other life-limiting condition. Dr. Kamal and his co-authors point to a “growing body of evidence [that] not only points to better quality of life and function for patients with cancer... [It also] suggests that relief from the pain, symptoms, and stresses of a serious illness and the prevention of the crises that result in avoidable hospitalizations actually helps patients with cancer complete their course of treatment and live longer.”

“If palliative care were a cancer drug, it could possibly be equivalent to a billion-dollar blockbuster.” Palliative care provided together with routine cancer care has been proven beneficial in a wide variety of ways. Chemotherapies that were once limited by nausea and infections can now be employed, to the benefit of the patient, thanks to palliative care. Patients can also avoid invasive procedures – like radical mastectomy – in favor of more limited options that respect the bodily integrity of the patient. Thanks to palliative care, patient experience can be addressed while also attending to the needs of curative treatment.

Anticipating the objections of some critics, Kamal and co-authors ask, “Does increased provision of palliative care run counter to the focus on curing cancer?” No. On the contrary, the simultaneous embrace of the latest advances in curative care and the full range of palliative therapies provide for the best possible experience for the patient – and the highest likelihood of survival. Furthermore, regardless of outcomes, the experience of living with cancer is unique and must be addressed in a holistic way. “Supporting patients and families through this unique experience requires careful attention, honed skills, and a recognition that sometimes an ‘extra layer of support’ … is valuable, and necessary.” Kamal et al argue for a “both-and” approach to cancer care and palliative therapies.

While fully supporting the new commitment to curing cancer once and for all, the authors urge the medical community to take a holistic view of the needs of people living with cancer. Beating cancer is not enough; we must also provide the human care that each one of us needs in times of life-threatening illness. “Cure without compassion is an exercise in killing malignant cells, while failing to support the living person.”

Source: (JAMA, 5/31, jama.jamanetwork.com/article.aspx?articleID=2526608)