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End-Of-Life Care For Cancer Patients Can Help Bring More Value To Life

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Today, on World Cancer Day, the goal is to raise awareness of the disease in order to hopefully prevent as many cases as possible in the future.

But the reality is, cancer continues to pervade people's lives, with statistics putting cancer deaths at 8.2 million people per year around the world — four million of which are people aged 30 to 69 years old.

Death is an important part of the conversation when it comes to cancer, which is why specialists have become focused on ensuring patients know their options when it comes to palliative care.

For Dr. James Downar, a critical care and palliative care staff physician at Toronto General Hospital, he's seen an increased recognition in the value of palliative care, and better adoption of it earlier on in the disease course.

"Palliative care is often thought of as speciality of medicine that is only given to people at the very end, and that’s not true anymore," he explains to The Huffington Post Canada. "Our intention is to help with symptoms and decision making, and that's often relevant much earlier than people realize."

Dr. Pippa Hawley, the palliative care program medical leader at the BC Cancer Agency, would prefer the conversations that can help these notions start even before you get sick. That's why she's started holding Bucket List Festivals across B.C., fundraising events to help people figure out how to make the most out of their lives when their time is limited.

As former patient Ian Dunlop Reid wrote on his blog about one of the events, "The best thing I took away was a reconnection with my own life — a reconnection that happened because I was forced to consider in a very practical way, my death."

While difficult to approach, advanced care planning is what can make the difference between patients feeling like they have some autonomy over their plan, and losing control. Decisions that have to be made include everything from which life-saving measures they will allow to who makes the decisions for them, if they're not able to themselves.

"In medicine, we tend to push forward regardless — we tend to have the desire to use aggressive care until people tell us to stop," explains Dr. Downar. "At any stage of illness, you want to start the conversation with your doctor about values and what’s important to you as a human being. People will get sicker, we won’t be able to fix an illness the way we want to, and when that happens, it’s important to know their final time will be spent in comfort."

Another aspect of the illness, according to Dr. Downar, is that statistically speaking, patients dying of cancer are younger than those dying of organ failure or frailty, and as such, are higher functioning until they're close to the end of their lives.

This can create even more difficulties as they quickly lose hold of things they valued or felt were defining to them as individuals, whether it was being able to do their jobs or simply going to the washroom without assistance. In those cases, it's more important than ever, says the physician, to help them figure out ways to get meaning back for their remaining time.

"Sometimes it's thinking about other goals, helping them discover something more achievable," says Dr. Hawley. "And as they progress in their illness, people also get better perspective, and realize they can function perfectly well without those things they thought they needed."

Of course, as physician-assisted dying becomes closer to becoming legal in Canada, it's also a topic about which many terminally ill patients are inquiring.

From a healthcare perspective, this can make the palliative care conversation all the more important, in order for people to better understand every one of their options.

"When people are first diagnosed with cancer or metastatic disease, they're frightened of what's coming, of being a burden on their families," says Dr. Hawley. "It's at that point they need to know the supports that are available and how they can access them, both for themselves and their families."

These supports can include anything from home care visits by nurses or physicians or equipment like electric beds that can help ease the transition from being fully functioning to requiring assistance — services that are often government-provided.

And according to the professionals, there is absolutely no reason to "tough it out" or feel like you're taking some kind of easier path when you accept help in the form of pain management.

"People shouldn’t feel like they need to choose between prolonging their life and being comfortable — they can really choose both," says Dr. Downar.

Most of all, the doctors stressed, patients need to know that their care team very much wants to have these conversations with them as soon as possible in order to best respect their wishes.

"I hated seeing people get treatments they didn’t want because they didn’t know how to have the conversation about not having them," says Dr. Hawley. "People need to consider a palliative approach to care alongside disease-modifying treatments when they still might get better. If they wait until they’re absolutely dying, it could be too little too late."
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