PALLIATIVE CARE

1. Dr. Kanhu Charan Patro
M.D,D.N.B[RT],P.D.C.R,C.E.P.C,FAROI
[EX – TATA MEMORIAL HOSPITAL]
Consultant- Radiation Oncology
MAHATMA GANDHI CANCER HOSPITAL
VISAKHAPATNAM
Email-drkcpatro@gmail.com ,M-09160470564
PALLIATIVE CARE AND RADIATION PROSPECTIVE

2. Emperor –THE ASHOKA
[273 BC-232BC]

4. What is Palliative Care?
 The WHO describes palliative care as "an
approach that improves the QOL of
patients and their families facing the
problems associated with life-threatening
illness, through the prevention and relief of
suffering by means of early identification
and impeccable assessment and treatment
of pain and other problems, physical,
psychosocial and spiritual."

5. Palliative care:
 provides relief from pain and other
distressing symptoms;
 affirms life and regards dying as a
normal process;
 intends neither to hasten or postpone
death;
 integrates the psychological and
spiritual aspects of patient care;
 offers a support system to help patients
live as actively as possible until death;

6.  Uses a team approach to address the needs
of patients and their families, including
bereavement counseling, if indicated;
 Will enhance QOL, and may also positively
influence the course of illness;
 Is applicable early in the course of illness,
in conjunction with other therapies that are
intended to prolong life, such as
chemotherapy or radiation therapy, and
includes those investigations needed to
better understand and manage distressing
clinical complications.

7. GOAL
 The goal is to improve the quality of
life for individuals who are suffering
from severe diseases.
 Palliative care offers a diverse array
of assistance and care to the patient.

8. History
 Started as a hospice movement in the 19th century,
religious orders created hospices that provided
care for the sick and dying in London and Ireland.
 In recent years, Palliative care has become a large
movement, affecting much of the population.
 Began as a volunteer-led movement in the United
states and has developed into a vital part of the
health care system.

9. Palliative vs. Hospice Care
 Division made between these two
terms in the United States
 Hospice is a “type” of palliative care
for those who are at the end of their
lives.

10. PALLIATIVE CARE
IS NOT
HOSPICE

11. Hospice
Palliative Care
All hospice care is palliative, but not all palliative
care is hospice

12. Palliative vs. Hospice
 Palliative care can be provided from the
time of diagnosis.
 Palliative care can be given
simultaneously with curative treatment.
 Both services have foundations in the
same philosophy of reducing the severity
of the symptoms of a sickness or old age.

13. Who needs?
 Individuals struggling with various diseases
 Individuals with chronic diseases such as
cancer, cardiac disease, kidney failure,
Alzheimer's, HIV/AIDS and Amyotrophic
Lateral Sclerosis (ALS)

14. Cancer and Palliative Care
 It is generally estimated that roughly 7.2 to 7.5
million people worldwide die from cancer each
year.
 More than 70% of all cancer deaths occur in
developing countries, where resources available
for prevention, diagnosis and treatment of cancer
are limited or nonexistent.
 More than 40% of all cancers can be prevented.
Others can be detected early, treated and cured.
Even with late-stage cancer, the suffering of
patients can be relieved with good palliative care.

15. Palliative Care and Cancer Care
 Palliative care is given throughout a
patient’s experience with cancer.
 Care can begin at diagnosis and
continue through treatment, follow-
up care, and the end of life.

16. Palliative Care and Cancer
 "Everyone has a right to be treated, and die, with
dignity. The relief of pain - physical, emotional,
spiritual and social - is a human right,"
{said Dr Catherine Le Galès-Camus, WHO
Assistant Director-General for Noncommunicable
Diseases and Mental Health.}
 "Palliative care is an urgent need worldwide for
people living with advanced stages of cancer,
particularly in developing countries, where a high
proportion of people with cancer are diagnosed
when treatment is no longer effective."

17. BY WHOM
 Usually provided by a team of individuals
 Interdisciplinary group of professionals
 Team includes experts in multiple fields:
 Doctors
 Nurses
 social workers
 massage therapists
 Pharmacists
 Nutritionists

18. Patient
and
Family
Volunteers Physicians
Spiritual
Counselor
s
Social
Workers
Pharmacist
s
Home
Health
Aides
Therapis
ts
Nurses

19. Approaches to Palliative Care
 Not a “one size fits all approach”
 Care is tailored to help the specific
needs of the patient
 Since palliative care is utilized to
help with various diseases, the care
provided must fit the symptoms.

20. Palliative Care Patient
Support Services
 Three categories of support:
1. Pain management is vital for comfort
and to reduce patients’ distress. Health
care professionals and families can
collaborate to identify the sources of
pain and relieve them with drugs and
other forms of therapy.

21. Palliative Care Patient
Support Services
2. Symptom management involves
treating symptoms other than pain
such as nausea, weakness, bowel and
bladder problems, mental confusion,
fatigue, and difficulty breathing

22. Palliative Care Patient
Support Services
3. Emotional and spiritual support is
important for both the patient and
family in dealing with the emotional
demands of critical illness.

23. What does Palliative Care
Provide to the Patient?
 Helps patients gain the strength and
peace of mind to carry on with daily
life
 Aid the ability to tolerate medical
treatments
 Helps patients to better understand
their choices for care

24. What Does for the Patient’s Family?
 Helps families understand the
choices available for care
 Improves everyday life of patient;
reducing the concern of loved ones
 Allows for valuable
support system

25. Approaches to Palliative Care
A palliative care team delivers many forms of help to
a patient suffering from a severe illness, including :
 Close communication with doctors
 Expert management of pain and other symptoms
 Help navigating the healthcare system
 Guidance with difficult and complex treatment
choices
 Emotional and spiritual support for the patient
and their family

26. Where?
 In most cases, palliative care is provided in
the hospital.
 The process begins when doctors refer
individuals to the palliative care team.
 In the hospital, palliative care is provided by
a team of experts.
 The Palliative Care Provider Directory of
Hospitals at www.getpalliativecare.org can
locate hospitals which provide palliative
care.

27. Settings for Palliative
Care
 Outpatient practice
 Hospital Inpatient
 Unit based
 Consultation Team
 Home care
 Nursing Home
 Hospice

28. Cost of Palliative Care
 Most insurance plans cover all or
part of the palliative care treatment
given in hospitals.

29. Palliative Care is Growing
 Data suggest there is growth in palliative
care programs throughout the nation's
hospitals, larger hospitals, academic
medical centers, not-for-profit hospitals, and
VA hospitals are significantly more likely to
develop a program compared to other
hospitals.

30. Pain Problems
 Route of administration
 Non drug methods
 Neuropathic pain
 Bone pain
 Incident pain
 Visceral pain
 Anaesthetic techniques

31. Respiratory Symptoms
 Breathlessness
 Cough
 Haemoptysis
 Stridor
 Pleural pain

32. GI Problems
 Nausea and
vomiting
 Obstruction
 Constipation
 Anorexia
 Cachexia
 Diarrhoea

33. Emergencies
 Some acute events
should be treated as
emergencies if a
favourable outcome
can be achieved.
 Hypercalcaemia
 SVC obstruction
 Spinal cord
compression.

34. Impact on patient with terminal diagnosis
“ Suffering”
• Physical
• Spiritual
• Emotional
• Psycho-social

35. Palliative care is not about whether to
treat or not to treat but about what is the
best treatment

36. • Hospice (home, hospital)
• Hospital based consult service or unit
• Clinic
• Home consultation
• Palliative home health programs
DELIVERY OF PALLIATIVE CARE

37. 53% of Americans die in hospitals

38. • Relieves pain and other symptoms
• Supports re-evaluations of goals of care and difficult
decision-making
• Improves quality of life, satisfaction for patients and
their families
• Helps patients complete life prolonging treatments
Palliative Care Improves Quality

39. You are not allowed eat

40. Oro-cheek fistula

41. Tracheo-esophageal fistula

42. Water bed-air bed

43. Wheel chair

44. Palliative rehabilitation

46. Massage

47. Counseling and giudence
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48. Emotional help
2/9/2021 48

50. METASTASIS
-please do not watch crying
50

51. 10/20/12 01:12 PM 51

52. METASTASIS- give a smiling
death
52

53. Palliative radiation
Skeletal X-Ray
Bone scan
MRI
PET-CT

54. Spinal metastasis
54

55. 55

56. Brain metastasis
56

57. 57

58. Whole brain radiotherapy
58

59. Choroidal metastasis
59

60. Superscan-extensive bone mets
60

61. Hemibody radiation
61

62. Prophylactic radiation
62

63. svco
63

64. CAUTION
C - Change in bowel or bladder habits
A - A sore that does not heal
U - Unusual bleeding or discharge
T - Thickening or lump in the breast or any part of the body
I - Indigestion or difficulty swallowing
O - Obvious change in a wart or mole
N - Nagging cough or hoarseness

65. Change in bowel habits
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66. Change in bladder habits
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67. A sore that does not heal
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68. Unusual bleeding or discharge
10/20/12 01:12 PM 68

69. Thickening or lump in the
breast or any part of the body
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70. Indigestion or difficulty
swallowing
10/20/12 01:12 PM 70

71. Obvious change in a wart or
mole
10/20/12 01:12 PM 71

72. Nagging cough or hoarseness
10/20/12 01:12 PM 72

77. Prevention-passive smoking

78. Liver cancer-
hepatitis B vaccine

79. Cervix cancer vaccine
10/20/12 01:12 PM 79

80. Promise-Stop drinking alcohol
10/20/12 01:12 PM 80

81. RELAX

82. Meditation
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83. 83
Dietary protective factors

84. Breast feeding

85. REGULAR CHECK-UP

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88. 88

89. Physical activity

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94. Just “Doing It” is not good enough !
You must know “what” to do and “where” to do it !
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Whenever not
possible,
make friends

98. 98
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100. 100
?

101. THANKS