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Palliative care | Ch 15 | |
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Although we make everyday progress in cancer treatment, cancer remains a mortal disease for about half of the patients, depending of the location (from 0% for localized tumour to 100% for rapidly progressive uncontrolled tumours or metastatic tumours).
(I muss confess that these are French historical remarks! Any comment from abroad is welcomed)
The history of palliative care for cancer patients is relatively old: during 18th century, Canon Jean-Baptiste Godinot founded in Reims an institute for 'cancerous' after many difficulties. His aim was to bring some dignity to patients, noticeably those with necrotic skin tumours, with strong odours.
In 1842, Jeanne Garnier, a young widow, creates in Lyons the 'Calvary Ladies', a lay congregation gathering lay widows who desire consecrate their life for untreatable patients. They install another house in Paris in 1874 (the future Jeanne Garnier medical house). With her, the word 'hospice' takes the meaning of a place to receive patients at the end of their life.
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In fact, most of the modern concepts of palliative care come from the works of Cicely Saunders at St Luke's Home for the Dying Poor (1946) then at St Christopher's Hospice. "I became conscious through listening to patients, that I perceived something of their capacity to transform this part of their life into a success". Since that time, her team used morphine preventively, invented the famous 'morphine elixir' and demonstrated the absence of habit in painful patients. Lady Cicely Saunders also originally expresses the concept of total suffering. Another important point was to explain why many caregivers were abandoning their patients at the end of life: it is the non acceptance of mortal characteristic of their patient (or of themselves). |
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Another pioneer in palliative care was Elisabeth Kübler-Ross, a Swiss physician living in Chicago. Her experience of dialoguing with patients was clearly demonstrated during a famous conference of 1961, when she let young medical students dialog with a young patient with leukaemia at the end of her life (something they had never done). She specifically studied the usual death denial among patients in terminal phase, but also in our society. She described the steps of the dying process. Also, like La Palisse's expression, she underlines the concept that a dying person lives until death. We should therefore help them up to this date. |
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The English model of hospices has spread around the world. The concepts of mobile team for palliative care and home care teams have then completed the original model. In France, after the revelation of the English experience by Father Patrick Verspieren, conferences from Dr Thérèse Vannier (Quebec), the experimentally work of Pr.Maurice Abiven (photo), many new teams are created and palliative care is progressively integrated in the University teaching. |
Most of these patients suffer from cancer.
A physician (or any caregiver) who will be in charge of cancer patient will have to provide palliative care. The continuous progress in palliative care, the more and more precise pain treatments are major progresses for the quality of life of our patient. For so many patients where nothing new happened for cure, we could write that palliative care is the only real progress for them.
That is the reason why I added this chapter to the course of general oncology.
Below are French legal texts about palliative care. Every country probably has its own legislation.
textes de lois et décrêts (for France)
Since, unfortunately, no all French universities integrate courses about palliative care, and due to the important role in cancer treatment (about half of our patients will need palliative care), I decided to hypertrophy this chapter.
They are only principles for treatments.
The named medications are reflecting my experience (or absence of experience). Names are DCI. Other medications may be useful, and I will be grateful to everyone who helps me correct mistakes or lapses.
Main subjects are treated like chapters with main pages and note pages. To come back to these main pages, the arrow just below should be pressed.
On each main page, the arrow below brings back to this page.
Page 2: Continuous and palliative care
Page 3: Pain
Page 4: Digestive tract problems
Page 5: Respiratory disorders
Page 6: Urinary disorders
Page 7: Neurological disorders
Page 8: Skin problems
Page 9: Nutritional and metabolic disorders
Page 10: Spiritual issues
Page 11: Terminal phase
Page 12: Cultural aspects
Page 13: Bereavement
Other chapters of this website
- Natural history of cancer
- Cancer prevention
- Cancer screening
- Cancer diagnosis
- Tumour markers
- Principles of Cancer Classification
- Cancer surgery
- Cancer radiotherapy
- Cancer chemotherapy
- Cancer hormonotherapy
- Other cancer therapies
- Multidisciplinary approach of cancer patients
- Psychological aspects
- Post-therapeutic follow-up
- Palliative care in cancer
- Cancer emergencies
References |
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Index |
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