Advanced–stage canceris a condition where cancer cells have spread widely, to multiple sites, or have metastasized to other organs. In addition to the main goal of treatment being to eliminate cancer cells,palliative careis equally important. In fact, it
can be initiated alongside the main treatment right away and does not need to wait until the cancer reaches an advanced stage.
can be initiated alongside the main treatment right away and does not need to wait until the cancer reaches an advanced stage.
What is Palliative Care?
Palliative careis carethat aims to enhance the quality of life for patients facing serious or chronic illnesses that may gradually worsen. It focuses on minimizing both physical and emotional pain as much as possible. This care encompasses managing
physical symptoms such as pain, difficulty breathing, and fatigue, as well as providing emotional, mental, social, and spiritual support. Both patients and their families receive comprehensive care and counseling to help them better cope with expected situations.
physical symptoms such as pain, difficulty breathing, and fatigue, as well as providing emotional, mental, social, and spiritual support. Both patients and their families receive comprehensive care and counseling to help them better cope with expected situations.
Palliative Care for Various Diseases
Palliative care can begin from the time a patient is diagnosed with a chronic illness that is likely to worsen or is in a stage where a cure is not possible, up until the end–of–life period. Examples include emphysema, chronic obstructive pulmonary disease(COPD),
end–stage renal disease (stage 5), dementia, Parkinson’s disease, and cancer. When patients understand their condition, possible complications, and the benefits of combining treatment with palliative care, it helps clarify the treatment goalsthrough
mutual agreement among patients, families, and doctors. This ensures that each stage of treatment aligns with the course of the disease.
end–stage renal disease (stage 5), dementia, Parkinson’s disease, and cancer. When patients understand their condition, possible complications, and the benefits of combining treatment with palliative care, it helps clarify the treatment goalsthrough
mutual agreement among patients, families, and doctors. This ensures that each stage of treatment aligns with the course of the disease.
Why is Palliative Care Important for Cancer Patients?
For cancer patients, palliative care plays a vital role at all stages of the disease. Cancer often causes severe symptoms and complications, whether from treatment or disease progression, such as intense pain, fatigue, rapid weight loss, difficulty breathing, nausea and vomiting, fluid in the lungs or abdomen, severe infections, high calcium levels, and overall physical decline. There is also anxiety and stress, especially for terminal–stage patients whose physical condition has weakened to the point where certain treatments like chemotherapy or radiation may no longer be suitable. Palliative care helps patients cope better with these challenges and allows treatment plans to be adjusted more appropriately.
The 5 Aspects of Palliative Care in Cancer Patients
1. Physical Care
Managing physical symptoms is central to palliative care, as cancer patients often experience severe symptoms that affect their quality of life. Examples include:
- Using non–steroidal anti–inflammatory drugs (NSAIDs), morphine, or fentanyl based on pain level.
- Prescribing anti–nausea medication depending on the cause, whether from chemotherapy, gastrointestinal blockage, or side effects from other medications.
- Addressing appetite loss and weight loss by using appetite stimulants, offering small, frequent meals, or providing medical nutrition or tube feeding when necessary. However, in terminal cancer stages, the digestive system slows down,
and overfeeding can lead to bloating or vomiting. Tube feeding may not be suitable as it increases the risk of infection, aspiration, and pneumonia, which can hasten death. - For breathing difficulties, positioning the patient correctly, using oxygen therapy, and administering low–dose morphine can help reduce breathlessness.
- If the patient has constipation, laxatives may be given, and the cause investigated. In the final stages of illness, more emphasis is placed on the patient’s comfort rather than curative treatment.
2. Psychological Care
Cancer patients often face stress, sadness, and anxiety. Psychological care focuses on helping them cope with negative emotions and fostering hope. Care from palliative specialists, psychiatrists, or psychologists can help manage emotions effectively. A calming environment—adequate lighting, good ventilation, and soothing music—can also help patients feel emotionally stable and peaceful.
3. Social Care
Social care aims to provide a supportive environment where patients can live with dignity and happiness. Illness and treatment often affect personal relationships and everyday life. Encouraging patients to join cancer support groups helps them share experiences and gain strength from others facing similar challenges. Participating in meaningful activities and receiving counseling can help reduce stress and foster emotional resilience.
Social care aims to provide a supportive environment where patients can live with dignity and happiness. Illness and treatment often affect personal relationships and everyday life. Encouraging patients to join cancer support groups helps them share experiences and gain strength from others facing similar challenges. Participating in meaningful activities and receiving counseling can help reduce stress and foster emotional resilience.
4. Spiritual Care
Spiritual care is tailored to align with the patient’s beliefs, religion, or sources of personal meaning. This may include visits from respected individuals, bringing meaningful objects, receiving forgiveness, fulfilling life goals, or having religious figures such as monks or spiritual advisors visit. Spiritual practices like prayer, meditation, mindfulness, or personal rituals can bring peace and meaning during life’s final moments.
5. Decision–Making Support
Patients and families are encouraged to make advance care plans with clear medical information, reflecting the patient’s true wishes. This includes decisions on life–sustaining procedures like intubation or CPR—whether to accept or decline certain treatments. Patients can create an Advance Care Plan and Living Will. They may also appoint a surrogate decision–maker who understands their preferences in case they become unable to decide for themselves. This process should involve the family, physicians, and the healthcare team to document and preserve the patient’s wishes, reducing confusion and ensuring a peaceful end–of–life experience.
Signs Before Death in Cancer Patients
End–of–life symptoms in advanced cancer patients vary by cancer type and health condition. Generally, patients may experience severe pain due to cancer spread, extreme fatigue preventing daily activities, changes in breathing such as labored or irregular
breaths, decreased appetite, significant weight loss, fluid retention causing swelling, reduced consciousness, frequent sleep, confusion, or hallucinations. The digestive system may slow or stop working. In the final stage, breathing may follow a pattern called Cheyne–Stokes respiration—cycles of deep, fast breathing followed by slowing and temporary stops. Blood pressure may drop, and the patient may become unresponsive. These are signs of a gradual approach to death. Palliative care ensures the best quality of life during this crucial time.
Palliative care plays a key role in enhancing the quality of life for both patients and families. It allows patients to spend their final days peacefully and meaningfully, while also helping families stay strong in supporting each other during this important time. At the Cheevajuk Center, Phyathai 1 Hospital, in addition to cancer specialists, there are also palliative care experts and a multidisciplinary oncology team ready to provide guidance, diagnosis, care, and treatment to help patients and families navigate every step with the utmost care and comfort.
