Palliative care
Emotional, spiritual and other support
When Angelina Voyevoda was diagnosed with late-stage cancer last year, her world collapsed. Just 34, with three kids and a stay-at-home husband, Voyevoda was suddenly hospitalized and told the aggressive cancer, which began in her lung and spread to her bones, could kill her within weeks.
She long ago beat those tough odds, thanks to the expert cancer care she’s received. And while the ensuing months have been challenging, Voyevoda says one key intervention — along with God — has helped her survive: palliative care.
“I’ve had help with so many problems — pain, insurance, depression, big decisions,” says Voyevoda. “It has made such a difference in my life.”
Long associated just with hospice, palliative care is rapidly gaining traction as a tool that enhances quality of life and may also improve survival. At UC Davis, palliative care is emerging as a centerpiece of the Supportive Oncology Program, reflecting evidence that its beneficial effects on symptom control and holistic well-being can help at any stage of a serious illness — not just the very end.
This spring, the UC Davis Comprehensive Cancer Center dramatically expanded its palliative care offerings with the launch of a specialized clinic that provides patients support services as a complement to standard oncologic treatment. Staffed by a doctor, nurse, social worker and chaplain, the clinic helps patients manage pain, stress and other challenges associated with cancer, including questions raised by the wide variety of treatments available today.
“One of the persistent myths about palliative care is that it’s only available at the very end of life, but there’s a strong body of research supporting its use simultaneously with disease-directed treatment,” says Nathan Fairman, the cancer center’s director of Supportive Oncology and Survivorship. “Patients who receive palliative care early on feel more in control of their care, less stressed and tend to have better outcomes.”
Palliative care is defined as specialized medical care for people with serious illnesses. Practitioners focus on reducing patients’ pain and other symptoms through an interdisciplinary approach that typically includes providing emotional and spiritual support.
Over the past decade, the field has expanded rapidly as public interest in palliative care has increased amid reports of its benefits. In 2000, less than one-quarter of U.S. hospitals had a palliative care program; by 2016, three out of four offered services, according to the Center to Advance Palliative Care.
Such growth reflects studies showing that patients who receive palliative care tend to fare better than those who don’t. Benefits include significant reductions in pain, fatigue, insomnia, depression and anxiety, as well as considerable improvements in overall quality of life and an enhanced ability to cope with a difficult prognosis.
Patients receiving palliative care early also are less likely to have late-in-life hospitalizations — including time in an intensive care unit or emergency room — than those who receive palliative care later, a 2015 study showed. Fewer visits mean lower hospital costs, with one study estimating that inpatient palliative care consultations are associated with more than $2,500 in net cost savings per patient admission.
Some research also has shown palliative care’s potential to improve survivability. One 2010 study of patients with metastatic lung cancer found that those who received palliative care along with standard oncologic care lived significantly longer than patients who did not receive palliative care.
Reflecting such findings, the American Society of Clinical Oncology (ASCO) in 2016 updated its guidelines to recommend that “inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment.”
“That was huge,” Fairman recalls, “because we had the most well-respected clinical oncology organization acknowledging that it’s best for the patient to have a specialist in palliative care working alongside the oncologist.”
Adoption of the ASCO guideline also shows how far palliative care has come. For years, its link with hospice gave it a bit of an identity problem, with many people misperceiving its value and assuming patients receiving such care had given up on life.
In addition, some oncologists viewed palliative care with distrust, assuming providers might dissuade patients from pursuing cancer treatments. Similar tensions surrounded the role of palliative care in a research institution with a mission to develop novel therapies to beat cancer.
“Patients sometimes reach a point where continued cancer therapy is no longer in line with their goals,” explains Fairman, an associate professor in the Department of Psychiatry and Behavioral Sciences. “When that happens, palliative care experts can help patients, their family members and their doctors come to a new decision about the focus on their medical care.”
At UC Davis, the investment in supportive oncology services has been growing steadily in recent years. Resources now include educational programs for patients and families, dedicated oncology social workers, psychiatric and spiritual support, a pain medicine clinic, and a home-based palliative care service for patients whose symptoms make traveling difficult.
Last year, the cancer center took another step forward by creating Fairman’s position. A psychiatrist with certification in hospice and palliative medicine, Fairman continues to see patients and teach courses while striving to expand and integrate support services across the cancer center’s continuum of care.
The full-service Palliative Care Clinic, which sees patients four days a week, might be called the pièce de résistance. In Fairman’s view, it dovetails perfectly with the “comprehensive” mission embedded in the cancer center’s name.
“I think our patients believe that when they come to UC Davis, they will be cared for comprehensively, as a whole person,” he says. “We need to honor that expectation, and our supportive oncology program aims to do just that.”
Fairman says the clinic also frees up oncologists to “focus like a laser on treating the cancer” while the support team helps patients with symptoms, side effects and the myriad non-medical issues triggered by serious disease.
“Someone with a serious cancer who maybe struggles with mental health problems or other complex medical issues can present a very challenging situation for oncologists,” says Fairman. “I think they appreciate being able to partner with another team of experts, to support patients and their family members while they are dealing with cancer.”
Voyevoda certainly does. The West Sacramento resident has undergone surgery, chemotherapy, immunotherapy and radiation for her cancer, and has experienced a cascade of symptoms and side effects, including significant pain.
But visits and phone support from her home-based palliative care team have made a difference. Her nurse and social worker have helped with medication adjustments, arranged a home visit by a specialist to treat an eye infection, mediated an insurance coverage dispute and even helped with logistics so that Voyevoda’s father could visit from Russia.
“We can call them any time, for any problem,” says Voyevoda. “Let me tell you, some people gave up on me, but not these people. I will never forget them.”