“Critical Care in Cancer Palliation” By Dr. Madhuri

“Critical Care in Cancer Palliation” presented on 2nd Nov 2008 during the Function “Diwali With a Purpose” by Dr. Madhuri – Medical Director

Although I was not in a position to speak due to health limitations, I dwelt upon a subject of thought “where to draw a line” during October 2006 and “Pain Management -vs- Sedation” during November 2007.

There are many undefined areas distinguishing active form of therapy from palliative care. Critical Care in cancer palliation is a new emerging concept, which is different from Critical Care in traditional hospitals providing active form of therapy.

It is common knowledge that the critical care in traditional hospitals includes procedures such as:

  • Ventilator support to respiratory system
  • CPR for cardio vascular resuscitation
  • Dialysis for maintaining kidney function etc.

These procedures are carried out to give temporary emergency support to a specific system, which is failing.

Critical care in cancer palliation has a different connotation. The main principles of cancer palliation being:

  • To manage physical and mental pain adequately to comfort the patients
  • To improve the quality of life as far as possible
  • To support the patient till the end

Compared to this, the emerging concept of Critical Care in cancer palliation includes minor procedures which relieve the painful symptoms and makes the patient comfortable so that he/ she breathe easily, eat or drink to maintain nutrition and hydration of body, pass stools and urine without difficulty/discomfort and sleep in comfort.

These include procedures such as :

  • Tracheostomy, pleural tapping
  • Ryles tube, Gastrostomy, Ascites tapping, Colostomy
  • Stent in oesophagus / common bile duct etc
  • Urinary catheter, etc

The concept of Critical Care in cancer palliation also includes admission to hospital for three to five days to:

  • Administer IV fluids to counter the reduced intake of oral fluids and to maintain hydration of the body
  • Keep the patient under observation and to address the problems, which really make the patient experience suffering/discomfort and cause restlessness
  • Give confidence that he/ she is being taken care of
  • Give reassurance to the patient that he/ she is not abandoned and to mitigate the mental and physical suffering of the patient

However, this Critical Care during cancer palliation does not include:

  • Extensive investigations
  • Extensive surgical interventions
  • Emergency support systems provided in Intensive Care Units under active form of therapy

Respite Care
There is another dimension to Critical Care in cancer palliation. A long drawn attendance of care giver/ family member with personal involvement, in looking after patient with a serious disease such as cancer, may cause a stress factor resulting in fatigue. Often such caregivers do not find convincing reasons to their own thoughts. Such family members who are deeply involved, experience a form of frustration due to helplessness in taking care of the patient resulting in stress/ fatigue.

Sometimes it may cause manifestation of some form of health disorder in the family member/ caregiver who does not accept the reality. This calls for an immediate correction or Critical Care in handling the family members.

When the family shows signs of fatigue, display panic symptoms and unable to manage the patient at home, three to five days admission of the patient in the hospital gives relief to family and psychological support to the patient that something is being done to relieve pain and suffering. This Respite Care goes a long way in comforting the patient, and the family by reducing the feeling of helplessness and frustrations that they are unable to do anything to help the patient. Hence Respite Care forms part of the concept of Critical Care in cancer palliation.

While cancer incidence is increasing exponentially, new concepts are emerging in all the fields involving cancer. So far as cancer palliation is concerned, the above are a few guidelines to define what a Critical Care means to a patient under palliation.

(The concept has evolved as a result of hard experience in providing Home care over fourteen years, constant interaction with the family members / care givers and understanding the needs of a patient undergoing cancer palliation. This followed establishment of a Critical Care Centre in the form of a ten bedded Hospital as a long felt need and the concept is put to test)

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