Palliative Care For Cancer
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
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.
What palliative care is
A definition
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.
| 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 |
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).
| 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.
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.
| 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
| 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
Mind, spirit and family
| 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 |
Caring for the family is part of caring for the patient.
Conversations that matter
Does palliative care mean the doctors have given up?
| 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 |
| 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 |
Where care happens
| 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 |
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
| 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 |
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
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.
| 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 |
| 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
| 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 |
| 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.
Medically reviewed by
Prof. Dr. Metin GÜDEN
Radiation Oncology
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