Many people mistakenly think that palliative care is the same as hospice care. It isn’t. Palliative care is medical care focusing on people who are seriously ill. It’s meant to help patients get relief from their symptoms, pain and stress; whatever their diagnosis.
Listen as Dr. Stefanie Mooney from City of Hope, answers questions about how providers, caregivers and patients can maximize the quality of life for themselves and loved ones through Palliative Care and managing those cancer symptoms .
Palliative Care and Symptom Management for Cancer Patients
Featured Speaker:
Learn more about Stefanie N. Mooney, MD
Stefanie N. Mooney, MD
Stefanie N. Mooney, MD is an assistant clinical professor in the Department of Supportive Care Medicine. Board certified in family medicine, Dr. Mooney holds active memberships with the American Academy of Hospice and Palliative Medicine and the American and California Academy of Family Practitioners. Her research focuses on the ways in which palliative medicine can improve both outpatient and inpatient care. She is also no stranger to volunteer work, having travelled on a monthly basis to Mexico to provide free health care for the community of Valle Redondo from 2008-2010.Learn more about Stefanie N. Mooney, MD
Transcription:
Palliative Care and Symptom Management for Cancer Patients
Melanie Cole (Host): Many people mistakenly think that palliative care is the same as hospice care, but it isn’t. Palliative care is meant to help patients get relief from their symptoms, pain and stress-- whatever their diagnosis. My guest today is Dr. Stephanie Mooney. She’s an assistant clinical professor in the department of supportive care medicine at City of Hope. Welcome to the show, Dr. Mooney. So, tell us the difference between palliative care and hospice care.
Dr. Stephanie Mooney (Guest): Hi, good morning. Thank you for having me on your show. Very commonly, we get patients and families who are a little bit intimidated by us as palliative physicians because they mistakenly confuse us as being the same as hospice. However, there are some very important differences. While both palliative care and hospice care focus on symptom management--things like pain, shortness of breath, nausea, as well as the emotional impact of a serious illness--hospice is a program that really focuses on end-of-life care in the last six months or so of a patient’s life. On the contrary, palliative care is really designed for any patient at any stage of their illness that is suffering from symptoms.
Melanie: So, when you speak about the fact that this can be with any illness and it’s the symptom management, what’s involved in palliative care?
Dr. Mooney: So, there’s several things that we focus on. Here at City of Hope, the majority of our patients, of course, are suffering from very advanced cancers, and this may result in things like pain, either related to the cancer itself or as an effect of their treatments for cancer. So, we will often do a very thorough assessment of whatever symptoms they may be dealing with which commonly involve pain. At times, it may involve nausea, constipation, and we do our best to help manage these symptoms whether it’s through the use of medications or whether it’s through the use of advice about different things that they can eat, about different exercises that may be helpful--really trying to focus on how we can best manage their symptoms that they can go through the treatment that they’re experiencing.
Melanie: Can someone have palliative care while they’re going through treatment? It doesn’t mean that if you’re doing palliative care that you have to stop other treatments or curative treatments.
Dr. Mooney: Absolutely. And it’s, again, a common misconception that you can have only palliative care once curative options for a disease such as cancer have gone away. However, as I previously said, many of our patients are receiving treatments for their cancer that come with side effects. The treatments in and of themselves are extremely important in order to prolong a patient’s life and, in time, may help their symptoms as well. And so, one of the things that we do as palliative physicians, is we help to manage those symptoms so that they are able to in fact complete their treatments.
Melanie: Is palliative care, Dr. Mooney, only medicational type intervention or are there other aspects to it, maybe spiritual care, psychological counseling--because if you are suffering from a disease, cancer or otherwise, there could be depression, stress, anxiety, all of these other issues can come into play.
Dr. Mooney: You’re absolutely right. Often we find that a symptom on the physical side doesn’t exist without a symptom on the emotional side as well. Each side really impacts the other. A person who is dealing with depression may have much more difficulty managing their physical symptoms. And so, I agree that it’s important for us to assess for these other emotional impacts as well, not only for the patient themselves but as well as for the family units. Another big focus of palliative care is recognizing that a patient does not exist on their own, that they are often a part of a family unit, and the disease process can impact the way that they view themselves, the way that they view their family members and their role in life. And so, frequently, we work very closely with other members of the department of supportive care including our psychiatrists, our psychologists and social workers who are all very, very skilled at managing some of these emotional issues that come up. Additionally, in palliative care, we’re trained to really try to seek out the values that a patient and their family has. Oftentimes, we get caught up in just what’s the next step in a patient’s care, but we tend to take a step back and really look at the big picture, what matters in a person’s life, and how can we best recommend a path in their care that is most aligned with their values.
Melanie: And, who is a palliative care physician? Does that person work with your physician or is your oncologist or physician that’s helping you with your disease, the person that would deal with the palliative care?
Dr. Mooney: Palliative care can be done in a number of ways. Here at City of Hope, one of the aims that we have is to help teach our colleagues in the process of primary palliative care, meaning that if we are able to help provide education to other physicians in other departments, we can reach so many more people. In addition, as secondary palliative care, when there’s a patient that is dealing with symptoms whether they be physical or psychological that are maybe a little bit more challenging, we are sometimes called in as specialty palliative physicians to come in and help assess the situation and determine how we might be able to best provide additional support.
Melanie: How long can someone receive palliative care?
Dr. Mooney: Really, as long as they’re having symptoms, that’s as long as they can receive palliative care. I've had some patients that I meet at the end of life; I've had other patients that I've known for years. So, it really is just dependent on the person, and if they have a serious illness and they have symptoms that need managing, we can be there.
Melanie: So, they don’t have to give up their own doctor, and who else besides the patient can benefit from palliative care? Does it involve any other members of the family?
Dr. Mooney: Absolutely. As I had mentioned, much of what a patient goes through is really impacted by the involvement of their family. Many cultures don’t make decisions for medical care on their own, they make it as the family unit. And so, it’s important that we involve the main family members whenever we’re having discussion about goals of care or really even when we’re discussing what are some ways that we can help a family to best understand what a patient is going through. Just the other day, I had a patient and his wife come in, and he’s been suffering from some difficulty with appetite which is, unfortunately, an expected part of his disease process. And so, what he’s been struggling with is working along with his wife, and they’ve always made a really good team. But, at this certain point in time, there’s been some frustration around his wife providing him food that he feels uncomfortable eating, and her feeling like he’s not trying, and he feeling like she’s pushing him. So, we attempted to really just reassess the situation and try to acknowledge that some of these symptoms are quite common, and that if we work to try to understand the different perspectives of the illness, both from the patient’s side as well as from the caregiver’s side, then we can hopefully work together better as a team.
Melanie: Can people get palliative care even if they’re at home during their treatments?
Dr. Mooney: They can. City of Hope does not have a home palliative program here. However, we do see patients on a outpatient basis in our clinic. Patients that are still ambulatory or can get around in a wheelchair come to see us in our clinic just as we see patients in the hospital when they are hospitalized. When there are patients whose disease progress is significantly advanced and their decisions have shifted away from curative treatment to more comfort oriented measures, that’s a point in time, when we, as palliative physicians, may work together with the primary oncologist and the rest of the team to determine whether a home program may be in a patient’s best interest based on their value such as something as a hospice program or a home palliative program.
Melanie: Does insurance recognize palliative care?
Dr. Mooney: It’s definitely been a challenge in our field. It’s something that I think has improved over time, but it is a specialty that City of Hope finds a lot of value in, and, hopefully, our patients find a lot of value in as well. So in spite of the fact that it is somewhat challenging to get fully reimbursed for our time and our services, we believe that it’s something that is so important that we find a way to make it happen.
Melanie: In just the last few minutes, Dr. Mooney, and what great information and so important for people that have a disease to hear from you, give your best advice about palliative care, really what they can expect from it for symptom management and why they should come to City of Hope for their care.
Dr. Mooney: Well, I would say, first of all to keep an open mind. We work together as a team with the oncologists, and our oncologists are really wonderful here, and they’re going to seek out the best treatments possible to help the disease process. In the meantime, keep an open mind and if you are suffering from any symptoms whether it be pain, whether it be depression or anxiety, reaching out to us or the primary oncology team reaching out to us, we can help guide the patients throughout their process from diagnosis through their treatment and hopefully through recovery and survivorship as well.
Melanie: Thank you so much for being with us today, Dr. Mooney. You’re listening to City of Hope Radio. And for more information, you can go to www.cityofhope.org. That’s www.cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Palliative Care and Symptom Management for Cancer Patients
Melanie Cole (Host): Many people mistakenly think that palliative care is the same as hospice care, but it isn’t. Palliative care is meant to help patients get relief from their symptoms, pain and stress-- whatever their diagnosis. My guest today is Dr. Stephanie Mooney. She’s an assistant clinical professor in the department of supportive care medicine at City of Hope. Welcome to the show, Dr. Mooney. So, tell us the difference between palliative care and hospice care.
Dr. Stephanie Mooney (Guest): Hi, good morning. Thank you for having me on your show. Very commonly, we get patients and families who are a little bit intimidated by us as palliative physicians because they mistakenly confuse us as being the same as hospice. However, there are some very important differences. While both palliative care and hospice care focus on symptom management--things like pain, shortness of breath, nausea, as well as the emotional impact of a serious illness--hospice is a program that really focuses on end-of-life care in the last six months or so of a patient’s life. On the contrary, palliative care is really designed for any patient at any stage of their illness that is suffering from symptoms.
Melanie: So, when you speak about the fact that this can be with any illness and it’s the symptom management, what’s involved in palliative care?
Dr. Mooney: So, there’s several things that we focus on. Here at City of Hope, the majority of our patients, of course, are suffering from very advanced cancers, and this may result in things like pain, either related to the cancer itself or as an effect of their treatments for cancer. So, we will often do a very thorough assessment of whatever symptoms they may be dealing with which commonly involve pain. At times, it may involve nausea, constipation, and we do our best to help manage these symptoms whether it’s through the use of medications or whether it’s through the use of advice about different things that they can eat, about different exercises that may be helpful--really trying to focus on how we can best manage their symptoms that they can go through the treatment that they’re experiencing.
Melanie: Can someone have palliative care while they’re going through treatment? It doesn’t mean that if you’re doing palliative care that you have to stop other treatments or curative treatments.
Dr. Mooney: Absolutely. And it’s, again, a common misconception that you can have only palliative care once curative options for a disease such as cancer have gone away. However, as I previously said, many of our patients are receiving treatments for their cancer that come with side effects. The treatments in and of themselves are extremely important in order to prolong a patient’s life and, in time, may help their symptoms as well. And so, one of the things that we do as palliative physicians, is we help to manage those symptoms so that they are able to in fact complete their treatments.
Melanie: Is palliative care, Dr. Mooney, only medicational type intervention or are there other aspects to it, maybe spiritual care, psychological counseling--because if you are suffering from a disease, cancer or otherwise, there could be depression, stress, anxiety, all of these other issues can come into play.
Dr. Mooney: You’re absolutely right. Often we find that a symptom on the physical side doesn’t exist without a symptom on the emotional side as well. Each side really impacts the other. A person who is dealing with depression may have much more difficulty managing their physical symptoms. And so, I agree that it’s important for us to assess for these other emotional impacts as well, not only for the patient themselves but as well as for the family units. Another big focus of palliative care is recognizing that a patient does not exist on their own, that they are often a part of a family unit, and the disease process can impact the way that they view themselves, the way that they view their family members and their role in life. And so, frequently, we work very closely with other members of the department of supportive care including our psychiatrists, our psychologists and social workers who are all very, very skilled at managing some of these emotional issues that come up. Additionally, in palliative care, we’re trained to really try to seek out the values that a patient and their family has. Oftentimes, we get caught up in just what’s the next step in a patient’s care, but we tend to take a step back and really look at the big picture, what matters in a person’s life, and how can we best recommend a path in their care that is most aligned with their values.
Melanie: And, who is a palliative care physician? Does that person work with your physician or is your oncologist or physician that’s helping you with your disease, the person that would deal with the palliative care?
Dr. Mooney: Palliative care can be done in a number of ways. Here at City of Hope, one of the aims that we have is to help teach our colleagues in the process of primary palliative care, meaning that if we are able to help provide education to other physicians in other departments, we can reach so many more people. In addition, as secondary palliative care, when there’s a patient that is dealing with symptoms whether they be physical or psychological that are maybe a little bit more challenging, we are sometimes called in as specialty palliative physicians to come in and help assess the situation and determine how we might be able to best provide additional support.
Melanie: How long can someone receive palliative care?
Dr. Mooney: Really, as long as they’re having symptoms, that’s as long as they can receive palliative care. I've had some patients that I meet at the end of life; I've had other patients that I've known for years. So, it really is just dependent on the person, and if they have a serious illness and they have symptoms that need managing, we can be there.
Melanie: So, they don’t have to give up their own doctor, and who else besides the patient can benefit from palliative care? Does it involve any other members of the family?
Dr. Mooney: Absolutely. As I had mentioned, much of what a patient goes through is really impacted by the involvement of their family. Many cultures don’t make decisions for medical care on their own, they make it as the family unit. And so, it’s important that we involve the main family members whenever we’re having discussion about goals of care or really even when we’re discussing what are some ways that we can help a family to best understand what a patient is going through. Just the other day, I had a patient and his wife come in, and he’s been suffering from some difficulty with appetite which is, unfortunately, an expected part of his disease process. And so, what he’s been struggling with is working along with his wife, and they’ve always made a really good team. But, at this certain point in time, there’s been some frustration around his wife providing him food that he feels uncomfortable eating, and her feeling like he’s not trying, and he feeling like she’s pushing him. So, we attempted to really just reassess the situation and try to acknowledge that some of these symptoms are quite common, and that if we work to try to understand the different perspectives of the illness, both from the patient’s side as well as from the caregiver’s side, then we can hopefully work together better as a team.
Melanie: Can people get palliative care even if they’re at home during their treatments?
Dr. Mooney: They can. City of Hope does not have a home palliative program here. However, we do see patients on a outpatient basis in our clinic. Patients that are still ambulatory or can get around in a wheelchair come to see us in our clinic just as we see patients in the hospital when they are hospitalized. When there are patients whose disease progress is significantly advanced and their decisions have shifted away from curative treatment to more comfort oriented measures, that’s a point in time, when we, as palliative physicians, may work together with the primary oncologist and the rest of the team to determine whether a home program may be in a patient’s best interest based on their value such as something as a hospice program or a home palliative program.
Melanie: Does insurance recognize palliative care?
Dr. Mooney: It’s definitely been a challenge in our field. It’s something that I think has improved over time, but it is a specialty that City of Hope finds a lot of value in, and, hopefully, our patients find a lot of value in as well. So in spite of the fact that it is somewhat challenging to get fully reimbursed for our time and our services, we believe that it’s something that is so important that we find a way to make it happen.
Melanie: In just the last few minutes, Dr. Mooney, and what great information and so important for people that have a disease to hear from you, give your best advice about palliative care, really what they can expect from it for symptom management and why they should come to City of Hope for their care.
Dr. Mooney: Well, I would say, first of all to keep an open mind. We work together as a team with the oncologists, and our oncologists are really wonderful here, and they’re going to seek out the best treatments possible to help the disease process. In the meantime, keep an open mind and if you are suffering from any symptoms whether it be pain, whether it be depression or anxiety, reaching out to us or the primary oncology team reaching out to us, we can help guide the patients throughout their process from diagnosis through their treatment and hopefully through recovery and survivorship as well.
Melanie: Thank you so much for being with us today, Dr. Mooney. You’re listening to City of Hope Radio. And for more information, you can go to www.cityofhope.org. That’s www.cityofhope.org. This is Melanie Cole. Thanks so much for listening.