Palliative care for cancer relieves pain, breathlessness, nausea, fatigue and anxiety at any stage, alongside chemotherapy, immunotherapy or radiation, and supports the family. Started early, it improved quality of life and mood and extended survival in trials. Our team combines symptom control, comfort procedures such as fluid drainage, psychological support and planning conversations, and arranges safe travel and care once you are back home.
About This Department
Medical Oncology
Palliative care treats the symptoms and the strain of cancer, alongside treatment of the cancer itself. Started early, it helps people feel better and, in trials, live longer.
Palliative care for cancer is specialist medical care focused on relieving pain, breathlessness, nausea, fatigue, anxiety and the other burdens of serious illness, and on supporting the family, at any stage of the disease and together with chemotherapy, immunotherapy, radiation or surgery. People confuse it with end-of-life care, yet most of its work happens months or years earlier. In a landmark trial of patients with newly diagnosed metastatic lung cancer, those who saw a palliative care team from the start had a better quality of life, fewer symptoms of depression and a median survival of 11.6 months against 8.9 months with standard care alone (Temel and colleagues, New England Journal of Medicine, 2010). International oncology guidelines now recommend it early for every patient with advanced cancer (Ferrell and colleagues, 2017). This page explains what palliative care is, the evidence for starting early, the symptoms it treats, procedures that bring comfort, support for the mind and the family, planning conversations, where care takes place, the last weeks of life, and how patients from abroad receive it at Biruni Hospital in Istanbul.
11.6
Months median survival with early palliative care in metastatic lung cancer, against 8.9 months with standard care
16
Percent with depressive symptoms at 12 weeks with early palliative care, against 38 percent
63
Percent alive at one year when palliative care began at enrollment, against 48 percent when it began three months later
Free
Review of your records and symptoms by our palliative care and oncology team
The World Health Organization describes palliative care as an approach that improves the quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering, physical, psychological, social and spiritual.
Palliative care is given by a team of doctors, nurses, psychologists, dietitians, physiotherapists and social workers trained in symptom control and communication. It works alongside the oncologist, who continues to treat the cancer. A patient can receive chemotherapy in the morning and see the palliative care team the same afternoon.
Three terms that are often confused
Term
When
Aim
Palliative care
Any stage, from diagnosis, alongside cancer treatment
Relief of symptoms and support for patient and family
Hospice care
When cancer treatment has stopped, usually the last months
Comfort and dignity at the end of life
End-of-life care
The last days to weeks
Comfort, closeness of family, a peaceful death
Palliative care does not replace treatment of the cancer, and choosing it never means giving up on it.
Starting early
Among patients with metastatic non-small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival (Temel and colleagues, 2010).
The finding surprised many oncologists. Patients in the palliative care group received less aggressive treatment in their final weeks, 33 percent against 54 percent, and still lived longer. Better control of symptoms, earlier treatment of depression and clearer decisions about when further chemotherapy would help are the likely reasons.
Trials of early palliative care
Trial
Patients
Main finding
Temel, 2010
151 with metastatic lung cancer
Better quality of life and mood, median survival 11.6 against 8.9 months
Zimmermann, 2014
461 with advanced cancer, 24 clinics
Better quality of life and satisfaction with care by four months
ENABLE III, Bakitas, 2015
207 with advanced cancer
One-year survival 63 percent with early start against 48 percent three months later
Why it is offered so late
The name frightens people.
Many patients and doctors hear the word palliative and think of the final days, so a referral feels like an admission of defeat, and it is postponed until symptoms become impossible to ignore. By then the chance to prevent months of avoidable pain, sleeplessness or anxiety has passed. The trials show the opposite approach works better. ASCO, the American Society of Clinical Oncology, recommends that patients with advanced cancer see a dedicated palliative care team early in the course of the disease, at the same time as active treatment, and that family caregivers be offered support as well. Some hospitals rename the service supportive care to ease the fear, and the care itself is the same.
Symptoms it treats
Pain, in the bones, nerves or organs, including breakthrough pain.
Breathlessness, cough and fluid on the lungs.
Nausea, constipation, loss of appetite and weight loss.
Many symptoms come from the cancer, others from its treatment, and some from both. Fatigue, poor sleep, low mood, confusion, itching, mouth sores and swelling are all treated. The team measures each symptom on a simple 0 to 10 scale at every visit so that changes are caught early.
Pain is the symptom patients fear most and the one that is controlled in nearly every case with the right medicines at the right doses. Our cancer pain management service covers it in depth.
Common symptoms and what helps
Symptom
Main causes
Treatments
Breathlessness
Tumor in the lung, fluid, anemia, weakness
Draining fluid, low-dose morphine, a fan, breathing techniques, oxygen when levels are low
Nausea and vomiting
Treatment, constipation, bowel blockage, high calcium
Anti-sickness drugs matched to the cause, correction of calcium
Constipation
Opioids, low activity, poor intake
Regular laxatives from the day opioids start
Loss of appetite
The cancer itself, taste change, low mood
Small frequent meals, dietitian advice, sometimes steroids
Fatigue
Anemia, sleep loss, depression, the disease
Treat the cause, pace activity, gentle exercise
Anxiety and low mood
The illness, uncertainty, pain
Talking therapy, medicines when needed
Every symptom is worth reporting. Many have a simple fix that no one offers unless asked.
Procedures for comfort
Fluid and blockages
Procedures that relieve symptoms
Procedure
For
Effect
Pleural drainage or an indwelling catheter
Fluid around the lung
Easier breathing, drained at home through a small tube
Paracentesis
Fluid in the abdomen
Relief of swelling and pressure
Stent in the bile duct, bowel or esophagus
Jaundice, bowel or swallowing blockage
Eating and digestion restored without an operation
Venting gastrostomy
Bowel blockage that cannot be opened
Stops vomiting, allows sips of liquid
These procedures take minutes to an hour, often under sedation, and many patients go home the same or next day.
Radiation and nerve blocks
1
Targeted relief
A single session of radiation eases pain from a bone metastasis in most patients within two to four weeks, and short courses stop bleeding or relieve pressure on the spinal cord. Nerve blocks, such as a celiac plexus block for pancreatic cancer pain, cut pain signals at their source and reduce the need for opioids.
Mind, spirit and family
Who is on the palliative care team
Team member
Role
When they help
Palliative care physician
Symptom control, medicines, overall plan
From the first visit
Specialist nurse
Daily symptom checks, teaching the family
Every day in hospital, by phone at home
Psychologist
Anxiety, depression, fear, adjustment
Whenever mood or coping becomes hard
Dietitian and physiotherapist
Eating, strength, mobility, breathing
Throughout
Social worker and chaplain
Practical matters, meaning, faith
On request
Serious illness raises questions that medicine alone cannot answer, about meaning, faith, family and what matters most. The team makes room for these conversations and brings in a religious leader of the patient's faith on request.
1
Support for caregivers
Family members carry a heavy load, often while working and caring for children. The team teaches them practical care, gives them a number to call, and offers them their own sessions with the psychologist.
Caring for the family is part of caring for the patient.
Conversations that matter
Does palliative care mean the doctors have given up?
No. It means a second team has joined, focused on how you feel while the oncologist focuses on the cancer. Many patients receive palliative care for years, during active treatment, and some go on to be cured.
Topics in advance care planning
Topic
Why it matters
Example
What you understand about your illness
Decisions start from shared facts
What the scans show, what treatment can achieve
What matters most to you
Guides every later choice
Being at home, attending a wedding, staying alert
Treatments you would or would not want
Avoids decisions made in a crisis
Intensive care, resuscitation, artificial feeding
Who speaks for you
If you cannot speak for yourself
A named family member
1
Talking about prognosis
Patients differ in how much they want to know. The team asks first, then answers honestly and at the pace the patient sets. Families who share the same understanding find later decisions easier.
How the goals of care shift
Stage
Main goal
Palliative care role
At diagnosis of advanced cancer
Control the cancer, live well
Symptom control, information, planning
When treatment options narrow
Balance benefit and burden
Weighing further treatment honestly
Last months
Comfort, time with family
Home support, hospice planning
These conversations are revisited as the illness changes, and a patient can change their mind at any time.
Where care happens
Settings for palliative care
Setting
Suits
What it offers
Outpatient clinic
Patients living at home, often still on treatment
Regular visits, medicine adjustment
Hospital consultation
Patients admitted for any reason
Rapid control of difficult symptoms
Palliative care unit
Severe or complex symptoms
Round-the-clock specialist nursing, family can stay
Home or hospice
Patients who want to be at home at the end
Visits, phone support, equipment
Most patients move between settings as their needs change. A short admission to bring severe pain or vomiting under control is followed by discharge home with a new plan.
The aim is to keep patients where they want to be for as long as possible.
At home
The team arranges equipment such as a hospital bed, oxygen concentrator or syringe pump for continuous medicine for home use, and families are taught how to use it before discharge.
The last weeks
Common changes near the end of life and what the team does
Change
What it means
What helps
More sleep, less interest in food and drink
The body is slowing down
Mouth care, small sips, no forced feeding
Noisy breathing
Secretions the patient can no longer clear
Repositioning, medicines to dry secretions
Restlessness or confusion
Common in the final days
Calm surroundings, family presence, gentle medicines
Pain or breathlessness
Needs may rise
Medicines by a small pump under the skin
Care in the last days focuses entirely on comfort. Tests and medicines that no longer help stop. The family is free to stay at the bedside day and night, religious and cultural wishes around death are respected, and the team explains each change so that nothing comes as a shock.
A peaceful death, free of pain and surrounded by family, is an outcome palliative care works toward with the same care as any other.
A note for families
Grief starts before the end.
Many families begin to grieve long before a death, and feel guilty for it. Grief of this kind is a normal response to a long illness. Rest when others offer to sit with your relative. Accept help with meals, children and paperwork. Tell the team when you are struggling. The palliative care team remains available after a death to answer questions about the last days and to point families toward bereavement support in their own country.
For patients from abroad
1
Length of stay and fitness to fly
A first stay of one to three weeks brings difficult symptoms under control and sets a plan for home. Fitness to fly depends on breathing, oxygen levels, pain control and the risk of clots, and the team assesses it before any flight and writes the airline medical form.
One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number once you are back home. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.
Flying home with a serious illness
Need
Arrangement
Notice required
Oxygen in flight
Airline-approved portable concentrator, booked with the airline
Several days before travel
Wheelchair or stretcher
Airport assistance or a stretcher seat
Stretcher seats need a week or more
Medical escort
A nurse or doctor travels with the patient
Arranged by the coordinator
Once you are back home, the team sends a detailed summary to your local doctor, and our palliative care physician remains reachable for questions by phone or video. Families facing the end of life far from home receive help with repatriation and with the practical steps that follow.
Traveling with medicines
Item
What we provide
Why
Opioids and other controlled medicines
A signed letter and prescription copy
Required at borders
Supply
Enough medicine to reach your own doctor
No gap in symptom control
Written plan
Doses, what to do for breakthrough symptoms
Your local team can continue it
Cost
What a quote for palliative care covers
Item
Included
Priced separately
Consultation
Palliative care physician visit and symptom plan
Repeat visits after discharge
Admission
Room, nursing, medicines for symptom control
Procedures such as drainage or stents
Support
Psychologist and dietitian during the stay
Medical escort and oxygen for travel
The price depends on the setting, the length of stay and any procedures needed. An outpatient consultation costs far less than an admission, and many patients need only a few visits.
Typical palliative care episodes
Episode
Usual length
Main components
Outpatient assessment
One to two hours
Consultation, symptom plan, prescriptions
Admission for symptom control
Three to ten days
Nursing, medicines, team visits
Procedure for comfort
Day case to three days
Drainage, stent or nerve block
References
Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742.
Bakitas MA, Tosteson TD, Li Z, et al. Early versus delayed initiation of concurrent palliative oncology care. Patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol. 2015;33(13):1438-1445.
Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer. A cluster-randomised controlled trial. Lancet. 2014;383(9930):1721-1730.
Ferrell BR, Temel JS, Temin S, et al. Integration of palliative care into standard oncology care. American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(1):96-112.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Prof. Dr. Metin GÜDEN, Radiation Oncology.
