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Cancer Control: Knowledge into Action: WHO Guide for Effective Programmes: Module 5: Palliative Care. Geneva: World Health Organization; 2007.

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Cancer Control: Knowledge into Action: WHO Guide for Effective Programmes: Module 5: Palliative Care.

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KEY MESSAGES

  • Palliative care is an urgent humanitarian need worldwide for people with cancer and other chronic fatal diseases. Palliative care is particularly needed in places where a high proportion of patients present in advanced stages and there is little chance of cure.
  • Ideally, palliative care services should be provided from the time of diagnosis of life-threatening illness, adapting to the increasing needs of cancer patients and their families as the disease progresses into the terminal phase. They should also provide support to families in their bereavement.
  • Effective palliative care services are integrated into the existing health system at all levels of care, especially community and home-based care. They involve the public and the private sector and are adapted to the specific cultural, social and economic setting.
  • In order to respond to the cancer priority needs in a community and make the best use of scarce resources, palliative care services should be strategically linked to cancer prevention, early detection and treatment services for both adults and children.

Key definitions

What is palliative care?

Palliative care (WHO, 2002a) is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment, and treatment of pain and other problems – physical, psychosocial and spiritual.

Palliative care:

  • provides relief from pain and other distressing symptoms;
  • affirms life and regards dying as a normal process;
  • intends neither to hasten nor to postpone death;
  • integrates the psychological and spiritual aspects of patient care;
  • offers a support system to help patients live as actively as possible until death;
  • offers a support system to help the family cope during the patient's illness and in their own bereavement;
  • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
  • will enhance quality of life, and may also positively influence the course of illness;
  • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy;
  • includes the investigations needed to better understand and manage distressing clinical complications.

Terminal cancer

Terminal cancer refers to an advanced stage when curative treatment is no longer useful, the disease is assessed to be incurable and the patient's condition is progressively deteriorating.

Figure 1 illustrates the continuum of care associated with curative and palliative care. Treatment intended to modify the disease decreases as illness progresses, while palliative care increases as the person reaches the end of life. Palliative care also provides support for the family during this entire period. After the patient dies, bereavement counselling for family and friends is important.

Figure 1. Integrated model of curative and palliative care for chronic progressive illness.

Figure 1

Integrated model of curative and palliative care for chronic progressive illness. Source: Adapted from American Medical Association Institute for Medical Ethics (1999). EPEC: education for physicians on end-of-life care. Chicago, IL, The Robert Wood Johnson (more...)

The quality-of-life dimensions of palliative care are illustrated in Figure 2. Palliative care is concerned not only with all aspects of the patient's needs, but also with the needs of the family and of the health-care providers.

Figure 2. Quality-of-life dimensions of palliative care.

Figure 2

Quality-of-life dimensions of palliative care. Source: WHO (2002a) National cancer control programme: policies and managerial guidelines, 2nd ed. Geneva, World Health Organization.

This Palliative care module focuses on cancer and does not specifically address other diseases, however, it recognizes the need for developing palliative care with a public health approach that targets all age groups suffering from diseases or conditions in need of palliative care. These conditions include HIV/AIDS, congestive heart failure, cerebrovascular disease, neurodegenerative disorders, chronic respiratory diseases and diseases of older people, among others.

Copyright © World Health Organization 2007.

All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution –should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: tni.ohw@snoissimrep).

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