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  arrow Palliative Care


Palliative Care : a life worth caring

The single most precious thing to each of us is our life. The life we have defines the person we are, what we were and the path that we take. Through the ages, lives are challenged, mainly by disease and others. In the past, medicine was concerned by the mortality of men by infectious diseases such as the plague. Through AIDS is now a concern worldwide, cancer grips the human population like no other illness.

Cancer surrounds us at all times. The Malaysian National Cancer Registry 2002, estimates that 1 in 4 Malaysians may get cancer and for some categories, we have rates that we should not be proud of. All of us have experienced cancer, from our loved ones, from the images that we see in the media, the warnings on cigarette packs, the work of social agencies and to our own sense of fear of this dreaded illness. But we also have hope.

There is much we know about cancer. That much is preventable, that screening will detect it earlier and that some may be curable. However, as much of humanity thrive on fear, we ignore the advice, the signs or symptoms and suffer needlessly.

For hundreds of years, care for the dying has taken place quietly and developed without much attention. In 1987, it was accorded the recognition of a medical specialty in the United Kingdom and has since developed all over the world, even in Malaysia. That Palliative Care remains largely unknown is mainly due to the reticence and awkwardness of both our medical community and public to address the issues that affect the suffering of people affected by advanced cancer.

Palliative Care deals with the recognition and understanding of the suffering of patients with cancer and other life threatening illness. It hopes that by a process of assessment and good management, the suffering of patients and families may be relieved and the maximum quality of life attained by all involved. The management of pain and other physical symptoms such as nausea, vomiting, breathing difficulties, bleeding and others may be improved by many ways. An emphatic understanding of the psychological, social and spiritual effects of disease will enable better treatment regimes and support measures to be given to patients and families.

Coping with cancer is undoubtedly difficult and many patients and their families use different techniques. From fear, denial, anger, bargaining and acceptance, they vary but common to all, they require clarification and information to the dramatic changes that are occurring to the vary fabric of their lives, the real possibility of losing a loved one. With this, patients and families will feel more comforted and perhaps are able to deal with their traumas more effectively.

It is important to understand that people suffer, diseases don’t. However, in much of our dealings with cancer, we sometimes treat them separately. We treat the growth or cancer in terms of it’s physical size or spread but do we take notice of the effect that it has on the person especially in terms of psychosocial impact? In the course of undergoing treatment, further changes may take place. The hair may fall out, there may be some nausea and feeling of weakness but the cancer may be beaten back. To be cured, to be in remission and to continue life as we knew it.

Patients behave differently in the face of dealing with advanced cancer. Some take a fighting stance, others become depressed or are resigned but many others are not given a chance to understand this illness as some families fear that open communication of cancer and it’s outcomes are detrimental to the patient. Discussions of cancer inevitably lead to an acceptance of our own mortality and our ability to countenance the loss of a loved one. We do have much to lose but fail to see that there is also much to gain.

In living with cancer, many patients suffer from pain and other severe symptoms. However, most pain is in fact, easily relieved by effective pain management strategies. In 1986, the World Health Organisation published guidelines for cancer pain relief which has been proven to work in up to 85% of cancer patients. This can be further improved with expert care. Many doctors are however unaware of such guidelines and many in the professional and community are influenced by myth and hearsay rather than factual data.

In dealing with cancer, we also have to accept that some will ultimately succumb to the illness. This final journey is often surrounded by darkness and fear and requires a great deal of information, knowledge and skill to manoeuvre such as to maintain a good quality of life for all. Truth and honesty are honourable traits, but often deceit, fear and collusion reigns.

Much suffering may be alleviated by a rational approach to the needs of cancer patients and their families. Palliative Care has evolved as a medical specialty for this specific need and the skills available allow care to be given to patients and families in a rational, holistic and achievable setting. The beginning of appropriate care of the cancer patient begins with ‘How are you?’ and an ability to listen.

Palliative Care is a part of a good cancer management plan. Do seek advice from your oncologist for appropriate palliative care referral.

  By Dr Ednin Hamzah  

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