END OF LIFE CARE AND PALLIATIVE CARE PACKAGE

 

DESCRIPTION OF CONDITION

 

Palliative Care is treatment, care and support for people with a life-limiting illness, and their family and friends. It’s sometimes called ‘supportive care.’

The aim of palliative care is to help you to have a good quality of life – this includes being as well and active as possible in the time you have left. It can involve:

  • managing physical symptoms such as pain
  • emotional, spiritual and psychological support
  • social care, including help with things like washing, dressing or eating
  • support for your family and friends.

A life-limiting illness is an illness that can’t be cured and that you’re likely to die from. You might hear this type of illness called ‘life-threatening’ or ‘terminal’. People might also use the terms ‘progressive’ (gets worse over time) or ‘advanced’ (is at a serious stage) to describe these illnesses. Examples of life-limiting illnesses include advanced cancer, motor neuron disease (MND) and dementia.

You can receive palliative care at any stage in your illness. Having palliative care doesn’t necessarily mean that you’re likely to die soon – some people receive palliative care for years. You can also have palliative care alongside treatments, therapies and medicines aimed at controlling your illness, such as chemotherapy or radiotherapy.

However, palliative care does include caring for people who are nearing the end of life – this is sometimes called end of life care.

End of life care involves treatment, care and support for people who are nearing the end of their life. It’s an important part of palliative care.

It is for people who are thought to be in the last year of life, but this timeframe can be difficult to predict. Some people might only receive end of life care in their last weeks or days.

End of life care aims to help you to live as comfortably as possible in the time you have left. It involves managing physical symptoms and getting emotional support for you and your family and friends. You might need more of this type of care towards the end of your life.

Palliative medicine is for people of any age, and at any stage in illness, whether that illness is curable, chronic, or life threatening. It focuses on improving a patient’s quality of life by managing pain and other distressing symptoms of a serious illness. Palliative care should be provided along with other medical treatments. http://palliativedoctors.org/

References

Department of Health. The NHS Cancer Plan: a plan for investment, a plan for reform. London: DoH. September 2000.

Hughes-Hallett T et al. Palliative care funding review. The right care and support for everyone. July 2011 [online]. AAvailable: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215107/dh_133105.pdf

Palliative care. GP Notebook [online]. Accessed: 24 November 2011. Available: http://www.gpnotebook.co.uk/simplepage.cfm?ID=1060438084

National Council for Hospice and Specialist Palliative Care Services. Definitions of Supportive and Palliative Care. Briefing paper 11. London: NCHSPCS. September 2002.

NICE 2004. Guidance on Cancer Services Improving Supportive and Palliative Care for Adults with Cancer http://www.nice.org.uk/nicemedia/live/10893/28816/28816.pdf

World Health Organization. National Cancer Control Programmes: policies and managerial guidelines. Geneva: WHO. 2002.

TREATMENT FEATURES AND BENEFITS

The main benefits are to relieve symptoms and pain associated the condition or the treatment stemming from it.

To help the patient and their loved ones understand that death is a natural part of life.

Not to promote dying or attempt to prevent it, but to take the journey with the patient.

Assist in spiritual and psychological care

Support the patient so that the patient can live their best life possible

TREATMENT STRATEGY DESCRIPTION

Osteopathy:  Dr. Still (founder of osteopathy) wrote: “To find health should be the object of the doctor. Anyone can find disease.” As Osteopaths caring for seriously ill, complex patients… it is our duty to find the Health in these patients who are most in need of nourishment in their withering fields.

The holistic approach of the osteopathic philosophy of practice incorporates all systems of the human body into an integrated therapeutic protocol. It addresses not just the disease process; rather, it embraces the patient and extended family. Some of the problems for end-of-life care that can be addressed and alleviated include the following:

  • Pain
  • Gastrointestinal dysfunction, including nausea, vomiting, ileus and constipation.
  • Cardiopulmonary problems, including shortness of breath and central and peripheral edema.

In general, hands-on treatment of the patient has many benefits. It can correct somatic dysfunction and provide a positive effect on the emotional state of the patient. It makes a patient feel worthwhile and not just a burden to those around them as they face their final days of earthly being. Performing gentle osteopathic manipulative therapy helps to decrease pain, improve circulation, and enhance gastrointestinal peristalsis and lymphatic flow. It also says to the patient, “I am here for you, and you are not alone.” The osteopathic approach is very effective in relieving pain, improving visceral function, reducing tension and stress, improving the doctor-patient relationship through touch.

In one of the studies, for more than seven years an osteopath has been working in the palliative care unit (PCU) and in both palliative care mobile team (PCMT) as a member of the multidisciplinary team. The patients referred to the osteopath by the palliative care physicians present pains related to cancer, but also to the treatment, in particular to surgery or radiotherapy. The osteopath can help with other symptoms such as constipation or dyspnoea. As this approach is provided in complement of the medicinal approach, it is not considered as an alternative medicine but as a complementary medicine associated to a conventional care.

Acupuncture for pain Management: Studies indicate that acupuncture may relieve pain in palliative settings and in addition, it may reduce the need for cancer pain drugs (Lu 2008). A recent systematic review found that acupuncture may provide long-term pain relief in patients with cancer (Paley 2011) and the most recent trials have strengthened the evidence (refer to the ‘Acupuncture for Cancer Care’ Fact Sheet, 2011). Acupuncture is beneficial to address pain arising indirectly from cancer treatments, eg., chemotherapy-induced neuropathy. Patients with HIV-associated neuropathic pain may also benefit.  Filshie (2003) reported that pain from cancer treatments is likely to respond better, and for longer, that that from the disease itself; nevertheless, there are still benefits possible for patients with late-stage cancer

 

Loss of appetite – Dry mouth (xerostomia)

Acupuncture is beneficial to treat radiotherapy-induced xerostomia (O’Sullivan 2010).  Acupuncture may also help with xerostomia dysphagia (swallowing difficulty) in late-stage palliative care (Filshie 2003).

 

Hydration or nutrition (Nausea and vomiting)

Recent studies suggest acupuncture can help relieve chemotherapy-induced nausea and vomiting (Lee 2010; Chao 2009; Ezzo 2006), especially in acute situations, and even self-administered acupressure may be effective.

 

Fatigue (Breathlessness)

Systematic reviews found low strength evidence that acupuncture/acupressure is helpful for breathlessness, with most of the studies on patients with COPD (Bausewein 2008). 

Hot flushes

The vasomotor symptoms brought on by chemotherapy treatment for breast and prostate cancer may be alleviated with acupuncture.

Fatigue – Other symptoms

Several pilot RCTs have found acupuncture to benefit patients with chemotherapy-related fatigue (Lu 2008). Acupuncture has also provided an alternative method for managing fatigue in patients with end-stage renal disease (Tsay 2004)

 

Mechanisms of Acupuncture in a Palliative Care Setting

Research has shown that acupuncture treatment may specifically benefit symptoms associated with palliative care by:

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009)
  • Regulating neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brain’s mood chemistry to help to combat negative affective states ( Cheng 2009; Zhou 2008;
  • Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010)
  • Improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling
  • Stimulating production of endogenous opioids that affect the autonomic nervous system, promoting relaxation and reduced stress Arranz 2007)
  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003)
  • Reversing stress-induced changes in behaviour and biochemistry (Kim 2009)
  • Increasing levels of T lymphocyte subsets such as CD(3), CD(4), and CD(8), as well as Natural Killer cells (Zhao 2010)
  • Relieving nausea and vomiting via central opioid pathways (Tatewaki 2005), regulating gastric myo-electrical activity (Streitberger 2006) , modulating the actions of the vagal nerve and autonomic nervous system (Huang 2005), and regulating vestibular activities in the cerebellum (Streitberger 2006)
  • Enhancing levels of vasoactive intestinal polypeptide and calcitonin gene-related peptide (O’Sullivan 2010), which may relieve xerostomia and hot flushes.
PACKAGE DURATION

8-10 weeks package, depending on patient general health and vitality.

CONSULTANT’S PROFILE AND EXPERIENCE

Khalid Mughal is a registered Osteopath and has postgraduate training in Sports and Exercise Medicine. He has worked in multidisciplinary teams and is a strong believer in integrative approach to healthcare. He has over 30 years’ experience working in this field.

CONTRAINDICATIONS

Acupuncture may be used to treat the person, some of the symptoms of cancer, and the side-effects of conventional cancer treatments, but it is not used to address the cancer itself.

Acupuncture needling is contraindicated in any area of actual or potential spinal instability due to cancer, as it potentially increases the risk of cord compression or transaction; directly over a tumour itself or nodules or related sites, such as ascites; when there is severely disordered clotting function; into a lymphoedematous limb (but see Cassileth 2011 below); directly above a prosthesis; or over any intracranial deficits following neurosurgery. Indwelling needles should not be used in patients at risk of bacteraemia, for instance in valvular heart disease and immune-compromised patients with neutropenia (Filshie 2003). It should be noted that acupuncture palliation of symptoms could mask both cancer and disease progression. Although the safety record of oncology acupuncture is extremely good, additional patient eligibility guidelines are in place in some countries, especially to protect against the possibility of infection in immune-compromised individuals (Lu 2010).

TESTIMONIALS
NUMBER OF SESSIONS AND PRICING

Two weekly sessions of gentle osteopathy, one acupuncture session a week.

Pricing – £1650

https://www.who.int/news-room/fact-sheets/detail/palliative-care

https://www.nhs.uk/conditions/end-of-life-care/what-it-involves-and-when-it-starts/

https://www.fouroakshealthcare.co.uk/blog/5-stages-of-palliative-care/

https://www.nice.org.uk/