HEALTH MATTERS: Who Should Be Thinking About Seeing a Palliative Physician

Palliative Care: Optimizing the Care Process for Patients and Loved Ones

Individuals living with chronic conditions often struggle with the stress and symptoms that accompanies their disease. Loved ones can also be affected, making it a difficult situation for all. To help ease the circumstances, many physicians are implementing palliative care, which focuses on improving the quality of life for both the patient and their family members.

Dr. Larry Cosner, an Internal Medicine Physician at Ridgecrest Regional Hospital, describes palliative care as being “sandwiched between” traditional care—where patients have curable diseases and are able to return to a normal, healthy life—and hospice, which focuses on making the last days of one’s life as comfortable as possible.

“Between those two is where a patient has a disorder that is either difficult to treat, or that we can only treat for some period of time, but their quality of life is good enough that they want to extend that time as long as possible,” he explains. “But, they also want to extend that time in a setting where their symptoms are as well controlled as possible.”

Which Conditions Benefit from Palliative Care?

One of the most common conditions palliative physicians treat is malignant cancers. In many cases, modern medicine may lack the ability to completely cure certain cancers but does have the ability to hold them at bay—either by reducing the cancer to not be visibly present or keeping it from growing larger for a substantial period of time. This can be months or sometimes even years.

“In that setting, somebody says, ‘Look, I know this cancer will probably take my life at some point in the future, but at the moment, my specialists are keeping it controlled and I want to be able to live my life as fully as possible. So, let’s let my specialists treat my cancer for now and I’m going to let my palliative physicians make sure I feel good enough to do the things I want to do.’ Like take that cruise, or go across the country to see grandchildren, or plant a garden. Or even the simple things like take care of their dog,” says Dr. Cosner.

Other conditions that might benefit from palliative care include serious cardiovascular or lung diseases.

Specialists Working Hand-in-Hand

Palliative care works best when the appropriate specialists work together to provide the optimal level of care. For example, an oncologist’s main goal is to keep a cancer that can’t be cured from growing, so they may not be focused as much on symptom control. That’s when another specialist can enter the picture and collaborate with both the patient and the oncologist to work on symptom management.

“Pain control is one crucial issue, and that’s complicated these days because as almost everyone is aware, we are in the midst of an opioid crisis,” notes Dr. Cosner. “But, many times, it’s also being able to address things like dizziness, dehydration, or itching. Sleeplessness is a common problem, as is weakness that is either due to the disease itself or the treatment. Those are all symptoms which might be addressed by the palliative care specialist.”

Loved Ones Can Act as Patient Advocates

Broaching the topic of palliative care isn’t easy, as it forces patients and family members to look towards a future they may not be ready to face. Dr. Cosner encourages his patients and their loved ones to not be fearful of the care process and to reach out for help.

“In some settings, the patient can’t even adequately articulate how bad they feel. So, having loved ones as part of that team who can talk about those symptoms is important. Loved ones often make conversations about the underlying disease more acceptable and easier to undertake if they remind everyone involved that none of us knows what’s going to happen in the future, and anything we talk about and anything we plan is not carved in stone. Let’s talk about how to approach things if they don’t go well, but let’s keep hoping that things are going to go well.”

**To listen to an interview with Dr. Larry Cosner, an Internal Medicine Physician at Ridgecrest Regional Hospital, follow this link: https://radiomd.com/ridgecrest/item/41257