Don’t get me wrong! I love the focus on Palliative care in Oncology but I still struggle with the concept “palliative oncology.”
For years we have heard the concept, “if it’s not curative, it’s palliative;” “Palliative chemotherapy;” and “palliative radiotherapy.” But the reality is we cure few diseases in medicine. But it is important to ask what we mean by a cure.
Five (5) year survival does not represent a cure. In fact most men in the US diagnosed with prostate cancer liver longer than 5 years but we still do not have a cure for metastatic prostate cancer. A disease is curable (not a person) if the population of people who get that disease die of something else. Yes that is a public health definition. Node positive breast cancer is not a curable disease. Women with that diagnosis continue to die of advanced breast cancer many years after diagnosis. Cure remains one of the goals of cancer control programs but the best chance of curing a disease are preventive measure together with early diagnosis and treatment; all without causing more toxicity from our therapy. That is not to say that we should not continue research to bring about cancer cures.
The primary goal of most oncology is to prolong survival either in terms of years or in some cases months to weeks. The other major goal is to palliate. We don’t (by intention) plan to have an impact on survival but we aim to make our patients more comfortable. A noble goal but for too long the palliation has been in the form of toxic therapies that go little to improve the quality of life let alone the impact on finances and lost opportunities. As one colleague has stated “We are selling hope in a plastic bag or a syringe!”
I am all for palliation and indeed palliative care!. In fact my favorite sayings of my good friend and colleague Geoff Hanks was in fact “Don’t take the Care out of Palliative Care!” All too often I now hear phrases such as “Palliative oncology,” “the palliative service” or just “we’ll get palliative to see them!’
So no objections to the increasing incorporation of palliative care in all forms of health care. Lets not take the care out of Palliative Care!