What is palliative care?
According to the WHO, “palliative care is an approach that improves the quality of life of patients and their families facing the problem 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”. In the Atlas of Palliative Care in Europe (http://www.eapcnet.eu), palliative care is defined as “the active, total care of the patient whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of social, psychological and spiritual problems is paramount”.
Pain and palliative care
In a survey of patients, family, physicians and palliative care providers, freedom from pain was ranked as the most important key component. A meta-analysis involving studies published in the past 40 years revealed that in advanced cancer conditions the prevalence of pain is around 60 %, while pooled prevalence across all cancer types is more than 50% 1. Study findings suggest that pain is also common and severe in advanced non-cancer conditions, and should thus also be addressed as a research priority and in service delivery strategies. Thus, pain is a central component of palliative care.
Analgesia and tranquility should be key components in patients with refractory pain throughout their disease progression and not solely as a terminal moment issue. However, it is recognized that pain management in palliative care is not satisfactorily addressed. Thus, management of pain in palliative care should be a priority in current health policies.
A new concept of palliative care
In our opinion, palliative care should be considered comprehensively, encompassing interventions that seek to modify and alleviate the course of the diseases. Thus, the concept of “palliative care” should be broadened to encompass patients with refractory, pharmaco-resistant, long-progression pain, with severe physical and psychological repercussions, including suicide risk. Those patients are not necessarily at the end of their lives, but nonetheless require pain palliation.
As chronic pain and its impact increase with age, the concept of palliative care should be adapted to the new European reality of increased life expectancy. Thus, it is necessary to encourage a broader scope of services being made available to a wider group of palliative care patients. Also, given that a substantial larger proportion of women suffer from chronic pain, palliative care should also take into account this reality.
1 van den Beuken-van Everdingen, M. H J, J. M. de Rijke, A. G. Kessels, H. C. Schouten, M. van Kleef, and J. Patijn, ‘Prevalence of Pain in Patients with Cancer: A Systematic Review of the Past 40 Years’,
Annals of Oncology, 18/9 (2007), 1437–49