From Pain to Palliative Care

Patsy Cibella, a 73-year-old lung cancer patient, moved with her husband from Florida to Boston to receive what she considers to be the world's most ambitious medical care. Patsy's cancer is incurable, and she is dying, but she has asked for more radiation therapy even if it extends her life by only a little.

Some patients and their families, like Patsy and her husband, want aggressive medical interventions at the end of life. But the wishes of those who do not, are not always carried out. American doctors are caught between the pressure to extend life and possibly causing patients real suffering. This is because Americans view medicine as a way to avoid death, says Boston University Health Law professor George Annas: "The longer we live the less comfortable we are with dying, the more we fear it and the more we look to medicine to try to cure it."

Annas says one answer to the skyrocketing costs of end of life care is an up and coming type of medicine that focuses almost entirely on relieving pain and other symptoms, palliative care. Palliative care aims to increase comfort while giving patients and their families the opportunity to explore treatment options beyond aggressive medical care while at the same time helping them to come to terms with the inevitability of death.

Josephine Monte, a 73-year-old grandmother, was diagnosed with advanced lung cancer three years ago. Since then, she has undergone dozens of rounds of chemotherapy and radiation, which leave her feeling miserable. She recently decided to postpone treatment so she could visit her autistic grandson in Florida. Monte knew delaying treatment would upset her family and oncologist, but her palliative care doctor supported her decision to make the trip her top priority.

Unlike Monte, who has had a close relationship with her palliative care doctor since her diagnosis, most palliative care providers are not called to service until a patient is ready to give up curative treatment and transition into hospice. But some studies are showing that when patients are started on palliative care at an earlier stage, they use less medical care and are more satisfied in their final months.