Cancer Survivorship and Palliative Care?

The role of specialist palliative care in individuals "living beyond cancer": a narrative review of the literature

PURPOSE

Many patients living beyond cancer experience significant unmet needs, although few of these patients are currently reviewed by specialist palliative care teams (SPCTs). The aim of this narrative review was to explore the current and potential role of SPCTs in this cohort of patients.

METHODS

A search strategy was developed for Medline, and adapted for Embase, CINAHL, and PsycInfo. Additionally, websites of leading oncology, cancer survivorship, and specialist palliative care organisations were examined. The focus of the search was on individuals living beyond cancer rather than other groups of cancer survivors.

RESULTS

111 articles were retrieved from the search for full text review, and 101 other sources of information were identified after hand searching the reference lists of the full text articles, and the aforesaid websites. The themes of the review encompass the definition of palliative care/specialist palliative care, current models of specialist palliative care, core activities of SPCTs, relevant expertise of SPCTs, and potential barriers to change in relation to extending their support and expertise to individuals living beyond cancer. The review identified a paucity of evidence to support the role of SPCTs in the management of patients living beyond cancer.

CONCLUSIONS

Individuals living beyond cancer have many unmet needs, and specific services are required to manage these problems. Currently, there is limited evidence to support the role of specialist palliative care teams in the management of this cohort of people, and several potential barriers to greater involvement, including limited resources, and lack of relevant expertise.

"Cured" but not "healed": The application of principles of palliative care to cancer survivorship

Application of principles of palliative care to the concept of survivorship may serve to establish an interdisciplinary approach to guide those treated for cancer through the experience of being "cured" but not "healed". Valuable lessons may be garnered from palliative care if its principles are considered within the context of survivorship. This work aims to define key terms including cured, healed, survivorship, and quality of life (QoL) and delineate the central tenets of palliative care and disease-modifying care. Since pursuit of a cure tends to dominate provision of oncological care, Western society's prevailing death denying attitudes often equate to the prioritization of advanced medial treatment to postpone death. Accordingly, the "modern paradox" of medicine (Cassell, 2004) is examined in consideration of the suffering that often results from advanced medical treatment that is intended to alleviate the cause of suffering and ultimately, "deny" death. However, owing to the profound consequences of advanced medical treatment and the associated losses of function concomitant with cancer, there is an apparent need for a framework of care that attends to these survivorship issues. When the experience of being cured but not healed is articulated through a theoretical discussion of liminality and the "remission society" (Frank, 1995), the applicability of palliative care to survivorship care becomes apparent. By embracing principles of palliative care, survivorship care may be guided by a theoretical foundation that provides cancer survivors with care that supports increased QoL, biopsychosocial symptom management, and a holistic perspective of the illness experience. Accordingly, application of palliative care to survivorship may establish congruence between notions of cured and healed.