Mrs A, is currently undergoing palliative chemotherapy for metastatic breast cancer (lung, liver, bone). She was complaining about lower back pain and also left lower ribs pain, caused by cancer spreading to her bones. I wanted to refer her to palliative care but she declined. She mentioned that palliative referral means that she is about to die soon. She added said she is not dying any time soon.
This is not the first time I encounter patients who refused palliative care referral.
Firstly, I must dispel one common misunderstanding about palliative care. Referral to palliative care doesn’t mean sending a patient to die. It’s never the case or intention by the oncologist.
In fact, we often refer patients with advanced/ metastatic cancer for EARLY palliative care so that patients can benefit from all the extra care offered by palliative team.
Multiple studies showed beneficial effects on quality of life and symptom intensity among patients with advanced cancer than among those given usual/standard cancer care alone (Haun MW, 2017).
I always believe whatever treatments that I gave for my advance/ metastatic cancer patients; be it chemotherapy, radiotherapy, targeted therapy, biologics therapy or immunotherapy, it will still be incomplete without a referral to palliative care.
As not many hospitals have their own palliative physician(s), many oncologists are trained to offer palliative care.
I had worked with few palliative physicians before and I can reassure you that they will come back to us (quite frequent!) with suggestions:
“I think this patient will benefit from some palliative chemotherapy”
- “I think palliative radiotherapy to this part will help alleviate the pain and reduce usage of morphine”.
Thus, referral to palliative is not one way only. Often, patients will be referred back to us for more treatment, if indicated and I will gladly comply to any request that benefit patients.
Most, if not all palliative physicians whom I am fortunate to learn from are so dedicated that they will came from far just to see one patient, doing walk rounds all over the hospital in crutches (mind you, it’s HKL!), spending hours sitting beside patients to explore their bothering symptoms, going to patient’s home when patient in crisis and etc.
Hopefully, when you’re referred to palliative care next time, please thank your doctor.
Better still, request for referral palliative care yourself and you’ll find your little angel holding your hand and easing all your sufferings, all the way until the end.