Palliative care is now offered concurrently with active colorectal cancer care to meet the complete needs of the Johns Hopkins patient. Palliative care is also called symptom management, with the health care team and patient working together to control the pain and other side effects of the cancer and its treatments.
Palliative care encompasses the physical and psychological, and is part of the integrative approach to medical care at Johns Hopkins. Complementary and alternative medicine (CAM) also includes palliative measures.
Palliative procedures are the recommended course of treatment for patients with colorectal cancer whose health is too fragile for surgical intervention. The Johns Hopkins colorectal cancer health care team looks at the overall health of a patient, as well as at the cancer, to determine the best outcomes and quality of life.
Colonic stents are implanted rarely and as a last resort for patients with colorectal cancer, for whom surgery would be life-threatening. A significant number of patients with colorectal cancer have an obstruction of the large bowel. Many of these patients are elderly, dehydrated, or in general ill health. For them, the risks of surgery outweigh the benefits.
The placement, via endoscopy, of an expandable colonic stent provides effective nonsurgical decompression of large bowel obstructions. The stent may be put in place quickly with very few complications. Guide wires are advanced across the stricture, or, obstruction. The guide wire is then substituted with a stiffer one. This is followed by the stent delivery system over the guide wire, in which the stent is deployed across the stricture. Long strictures may require overlapping, endoluminal, colonic wall stents.
The colonic stent technique has been shown to be safe and effective in resolving obstructions in the majority of patients. However, follow-up studies, using larger numbers of patients for a longer duration of study, are needed to assess accurately the utility of this therapy.
For patients who are temporarily unable to undergo surgery to alleviate an obstruction of the large bowel, preoperative colonic decompression with an expandable stent often allows the postponement of surgery until the patient’s bowel can be adequately cleansed, and/or, the patient’s general health is stabilized.
Patients can prepare for the rigors of colorectal cancer treatment and lessen the severity of side effects by monitoring their dietary and nutritional needs. Even when treatment is no longer an option, the palliative nature of eating well can assist the patient in maintaining the best quality of life possible.
Hospice care is the use of palliative care in circumstances where further treatment would be ineffective. Hospice care allows the patient the best quality of life care despite the outcome.
Palliative Care Resources
The following are useful resources on palliative care for patients and their caregivers:
American Academy of Hospice and Palliative Medicine
American Hospice Foundation
American College of Physicians