This document discusses palliative treatment for cancer patients. It begins with an introduction to palliative care, noting that the goal is to optimize quality of life and mitigate suffering for those with serious illnesses. It then discusses the goals of palliative care, including minimizing pain, treating symptoms, keeping patients mobile, and ensuring understanding. The document also covers palliative treatment options like chemotherapy, radiation therapy, and surgery. It provides examples of palliative treatment for specific cancer types such as lung cancer, liver cancer, and breast cancer. Throughout, the focus is on improving quality of life rather than cure.

1. Assignment on: Palliative Treatment for cancer patients.
Course title: Clinical Pharmacy
Course code: PHARM - 4104
Submitted to:
Mantasha Tabassum
Assistant Professor
Department of pharmacy
Comilla University
Submitted by:
Md Azizul Islam
ID. 11715031
Session :2016-17
Department of pharmacy
Comilla University
Date of submission: 30th
July,2021

2. Contents
Introduction ..................................................................................................................................................3
Goals of palliative care..................................................................................................................................3
Principles of palliative care...........................................................................................................................4
Disease types and palliative care..................................................................................................................5
Palliative treatment ......................................................................................................................................6
Palliative chemotherapy ...............................................................................................................................6
Palliative radiation therapy...........................................................................................................................7
Types of palliative cancer treatments...........................................................................................................7
Palliative treatment for various types of cancer...........................................................................................8
Benefits of palliative treatment..................................................................................................................12
Conclusion:..................................................................................................................................................13
References ..................................................................................................................................................14

3. Introduction
There is an ever-growing number of cancer patients in the world today.Of the estimated nine
million new cancer cases diagnosed in 1997 worldwide, 52% occurred in developing countries.
There is no cure to date for this disease but definitely a lot can be done to make the lives of these
people meaningful and productive. With this idea the concept of palliative care was initiated.
Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of
life and mitigating suffering among people with serious, complex illness. Within the published
literature, many definition of palliative care exist. The World Health Organization describes
palliative care as “an approach that improves the quality of life of patients and their families facing
the problems associated with life-threatening illness, through the prevention and relief of suffering
by means of early identification and impeccable assessment and treatment of pain and other
problems, physical, psychosocial, and spiritual. In the past, palliative care was a disease specific
approach, but today the World Health Organization takes a more broad approach, that the
principles of palliative care should be applied as early as possible to any chronic and ultimately
fatal illness. Palliative care is appropriate for individuals with serious illnesses across the age
spectrum and can be provided as the main goal of care or in tandem with curative treatment. It is
provided by an interdisciplinary team which can include physicians, nurses, occupation and
physical therapists, psychologists, social workers, chaplains, and dietitians. Palliative care can be
provided in a variety of contexts including hospitals, outpatient, skilled-nursing, and home setting.
Although an important part of end-of-life care, palliative care is not limited to individuals near
the end of life. Evidence supports the efficacy of a palliative care approach in improvement of a
patient’s quality of life.
Goals of palliative care
Palliative care is a special type of medical care used to treat patients with serious illnesses. This
specialized care can be used in conjunction with curative treatment or hospice care. Our
organization seeks to assist patients in need of palliative care by addressing care by addressing a
number of needs.
Minimizing pain
Many long-term or terminal illnesses cause physical pain for the patient. We work with the Patients
regular medical team to find the proper clinical methods to ease the pain as much as possible.
Treating symptoms
Of course, pain is not the only symptom of illness. Our facility works to identify additional
symptoms and treat them for patients with long-term illnesses. Harbor Light Hospice focus- es on
symptoms management for chronically ill patients or patients with a terminal diagno- sis. Our team
will do everything we can to ease physical and emotional discomfort caused by the symptoms of
a disease or medical treatment.
Keeping patient’s mobile

4. A key ingredient to a higher quality of life, regardless of whether an illness is long-term or
terminal, is keeping the patient as mobile as possible. We aim to help patients remain as active as
they can through walking, sitting up, and other forms of physical movement. Safe- ty precautions
are an essential part of this step.
Meaningful interactions with people and self
Emotional and psychological health treatment is just as important as physical treatment for patients
who suffer from serious illness. Our goal is to ensure that patients remain in active relationships
with family, friends, loved ones, and caregivers. In addition, we use various forms of therapy,
including art therapy and pet therapy, to assist with the patients emotio- nal well-being.
Ensures understanding
Our professionals explain the patient’s condition to them as well as to any caregivers in easy to-
understand languages so that all involved can make well-informed decisions about treatment
options.
Relief for caregivers
Our organization understands the difficulties that arise when caring for a loved one. We can
provide the hands-on help or respite for caregivers to allow everyone involved to remain as stress
free as possible during difficult times. If you someone you know might benefit from palliative
care, allow us to help you understand your options. Call Harbor Light Hospice or contact us online
for support.
Principles of palliative care
 Respect the likes and dislikes, goals choices of the dying person.
 Integrate the psychological and spiritual aspects of patient care.
 Offer a support system to help patient live as actively as possible until death.
 Patient centered rather than disease focused.
 Concerned with healing rather than curing.
 Affirms life & dying as normal process i.e as a part of the life cycle.
 Builds ways to provide excellent care at the end of the life.
 Through education of care providers, appropriate health policies and adequate
funding from insurers and the government.
 Provides relief from pain and other distressing symptoms.
 Death accepting but also life enhancing.
 Intends neither to hasten nor post pone death.
 Adds life to days and not days to life.
 Partnership between the patient and the care providers.
 Supports the need of the family members.

5.  Helps them in gaining access to needed health care providers & appropriate care
settings.
 Involving various kinds of trained providers in different setting tailored to the needs
of the patient and his or her family.
 Offers support system to help the family to cope during the patient’s illness and in
their own bereavement, including the needs of children.
 Uses a team approach to address the needs of patients and their families including
bereavement, counseling, if indicated.
 Enhance the quality of life, may also positively influence the course of a patient’s
illness.
Disease types and palliative care
The goal of palliative care is to improve quality of life. Palliative care specialists treat people
living with many disease types and chronic illnesses. These include cancer, cardiac disease such
as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), Kidney
failure, Alzheimer’s, Parkinson’s, Amyotrophic Lateral Sclerosis (ALS) and many more.
Palliative care is also essential for patients with CCOVID-19. Palliative care focuses on the
symptoms and stress of the disease and the treatment. It treats a wide range of issues that can
include pain, depression, anxiety, fatigue, shortness of breath, constipation, nausea, loss of
appetite and difficulty sleeping. Palliative care teams improve your quality of life. They do this
by helping you tolerate medical treatments, helping you match your goals to your treatment
choices, supporting your family caregivers and more. Learn more about how palliative care help:
• ALS
• Alzheimer’s Disease
• Breast Cancer
• Bone Marrow Transplant
• Cancer
• Chronic Obstructive Pulmonary Disease (COPD)
• Colon Cancer
• Congestive Heart Failure
• COVID-19  Dementia
• Eosinophil Associated Disease (EAD)
• HIV/AIDS
• Huntington’s Disease
• Kidney Disease
• Leukemia and Lymphoma
• Liver disease

6. • Lung Cancer
• Multiple Myeloma
• Multiple Sclerosis
• Ovarian Cancer
• Stroke
Palliative treatment
Medical treatment is a key part of palliative care. It aims to manage the physical and emotional
symptoms of cancer without trying to cure the disease. There is no single program of palliative
treatment. The treatment you are offered will be tailored to your individual needs and will depend
on the type of cancer you have, how far it has spread, your symptoms, and the amount of support
you have. Some examples of palliative medical treatment are:
• Radiation therapy to reduce pain
• Chemotherapy or targeted therapy to stop the cancer growing into other organs 
Surgery to reduce tumours causing pain or other symptoms  Medicines to control
symptoms and relieve discomfort.
The information below describes cancer treatments that can be used palliatively. If you are having
these treatments, you may experience side effects, such as nausea or fatigue. Let your palliative
care team know about any side effects so they can be managed.
Palliative chemotherapy
Chemotherapy can be given in a number of different ways, and it’s been found that many people
do not understand the distinctions. These include:
• Chemotherapy with a curative intent: With some cancers, such as acute leukemias,
chemotherapy may be used with the goal of curing the cancer.
• Neoadjuvant chemotherapy: With a neoadjuvant approach, chemotherapy is given before
surgery in order to reduce the size of a tumor so that surgery can be performed. In this
sense, it is also a curative approach.
• Adjuvant chemotherapy: Many people are familiar with adjuvant chemotherapy, or the type
of chemotherapy given after surgery. With this approach, the goal is to get rid of any
remaining cancer calls that may have traveled beyond the site of the original tumor in order
to reduce the risk of recurrence.
• Palliative chemotherapy: Palliative chemotherapy, unlike other approaches, is not designed
to cure a cancer. It may reduce the size of a cancer and improve symptoms, and in some
cases, may extend life for a short period of time.

7. While distinguishing these different goals is important, a large study found that the majority of
people having chemotherapy for stage 4 cancer did not understand that there was little chance it
would cure the disease. Since chemotherapy can carry significant side effects, people who are
considering palliative chemotherapy need to understand the goal of therapy so they can make a
personal decision as to the benefits and risks of treatment themselves.
Palliative radiation therapy
Palliative radiation therapy is used in a similar way. The goal of treatment is to decrease
symptoms even if the radiation is unable to cure cancer. That said, palliative radiation can
significantly improve the quality of life for people who are dealing with bone pain frombone
metastases, spinal cord compression who have respiratory symptoms due to obstruction of an
airway, and much more. Usually on the side of drugs like steroid and oftentimes surgical
intervention, palliative radiation may also reduce the risk of neurological damage that could lead
to paralysis.
Types of palliative cancer treatments
 Surgery
Cancer surgery removes the tumor and nearby tissue during an operation. A doctor who treats
cancer with surgery is called a surgical oncologist. Surgery is the oldest type of cancer treatment.
And it is still effective for many types of cancer today.
Remove tumours from affected areas, such as the bowel or lymph nodes.
Relieve discomfort caused by tumours blocking organs or pressing on nerves.
Improve outcomes from chemotherapy and radiation therapy by reducing tumour size.
Insert a thin tube into a blocked organ to create a passage for substances to pass through.
 Drug therapies
Drugs are delivered into the bloodstream so the treatment can travel throughout the body. This is
called systemic treatment, and includes:
Chemotherapy-The use of drugs to kill or slow the growth of cancer cells
Hormone therapy- Drugs that stop the body's natural hormones from helping some cancers to
grow
Immunotherapy -Treatment that triggers the body's own immune system to fight cancer
Targeted therapy- Drugs that attack specific molecules within cells that help cancer grow.

8. Some drug therapies can shrink a cancer that is causing pain because of its size or location; slow
the growth of the cancer; and help control symptoms, including pain and loss of appetite. Other
drug therapies can reduce inflammation and relieve symptoms such as bone pain.
 Radiation therapy
The use of a controlled dose of radiation to kill or damage cancer cells so they cannot grow,
multiply or spread. Radiation therapy can shrink tumours or stop them spreading further.
It can also relieve some symptoms, such as pain from secondary cancer in the bones.
Palliative treatment for various types of cancer
1) Palliative treatment for lung cancer:
Palliative chemotherapy may increase survival, and in some cases can improve pain
and other symptoms. Palliative chemotherapy means chemotherapy given primarily
for rapid relief of symptoms, not non-curative chemotherapy. Dyspnea related to
pulmonary parenchymal toxicity from chemotherapy should be managed with
discontinuation of the chemotherapeutic regimen and institution of steroids. This is a
delicate balance in using chemotherapy to the full extent possible to relieve symptoms
and reverse the underlying disease while also monitoring closely to determine when
the chemotherapy may be adding to symptom burden and thus should be discontinued.
2) Palliative treatment for liver cancer
This type of cancer often doesn’t show signs until its later stages, which makes it
difficult for doctors to detect early. Liver cancer also tends to occur in people with a
history of liver disease and other conditions, such as cirrhosis, chronic hepatitis B, or
hereditary hemochromatosis, making it a complex type of cancer to treat and cope
with. You can begin palliative care right after you’re diagnosed with any serious
disease, including liver cancer. Palliative care can help improve your quality of life
when you’re coping with liver cancer and undergoing treatments. You’ll start the
process with a palliative care consultation. You can prepare for the appointment by
making a list of symptoms you’re experiencing and noting how they affect your daily
life. You should also let the palliative care specialist know which medications and
supplements you’re taking. Your palliative care consultation will involve an in-depth
discussion about your treatment, your symptoms, and the effects of liver cancer on you
and your family. Then, you’ll work together to develop a goal-focused plan to ease
symptoms and maximize your quality of life. Palliative care plans vary widely among
people with liver cancer due to the complicated nature of the disease and the high
likelihood of coexisting conditions.

9. 3) Palliative treatment for esophageal cancer
Palliative esophagectomy or bypass procedures are difficult to justify in these patients
because their life expectancy is so short. Palliative external beam radiation to doses of
50 to 60 Gy is successful in 50% to 70% of patients. The addition of brachytherapy
may improve these results. One third to one half of patients treated with radiation
develop benign or maglinant stricture. Although response rates to combination
chemotherapy are only 50% at best, the majority of patients do have improvement of
dysphagia. These regimens are commonly used as part of a multidisciplinary approach
with radiation or surgery, rather than as a sole modality of treatment. Chemo-radiation
regimens results in better survival than treatment with radiation alone, and provide
palliation of dysphagia in up to 90% of patients. Although acute toxicity of
chemoradiation is more severe than radiation alone, this is of limited duration.
Chemoradiation may be the treatment of choice for the majority of patients with
locally advanced esophageal cancer. Endoscopic techniques are available that provide
palliation of dysphagia. The most commonly used technique is esophageal dilatation,
either alone or before performing other palliative procedures such as laser therapy or
stent placement. The most significant limitation of dilatation alone is that palliation is
short-lived and most patients require repeat dilatations. Esophageal stents offer a high
degree of palliation, but procedure-related morbidity and mortality rates are not
insignificant. Expandable metal stents are associated with few complications but
tumor ingrowth through the metallic mesh is frequent. Conventional plastic stents are
not affected by tumor ingrowth but can migrate. Endoscopic laser therapy also
provides symptoms relief and complication rates are relatively low. It is possible that
a combination of laser therapy and external beam or intraluminal radiation will provide
more durable palliation than laser treatment alonea variety of treatment options exist
for the management of tracheoesophageal fistulae, but only radiation therapy or bypass
surgeyr appear to prolong survival. Radiation therapy does not appear to worsen the
TEF as was commonly thought in the past, and it is likely applicable in more patients
than is surgery. The challenge for the physician in palliating patients with esophageal
cancer is to select therapy appropriate for a given patient, taking into account the
patient's disease, coexisting medical problems, performance status, and the patient's
desires.
4) Palliative treatment for breast cancer
Breast cancer patients often have to choose from among different treatment options,
which can include surgery, chemotherapy and radiation. But treatments have a variety
of side effects, such as pain, nausea and vomiting, fatigue, shortness of breath,
depression and constipation. This is where palliative care comes in. Palliative
medicine, or palliative care, is specialized medical care focused on relief of the pain,
symptoms and stress of a serious illness such as breast cancer. The goal is to improve

10. quality of life for both you and your family. Palliative care is appropriate at any age
and at any stage in your illness, and it can be provided along with curative treatment.
The oncologist, surgeon and radiation doctors are experts at treating breast cancer. But
the disease is only a part of what patients struggle with. When palliative care teams
work in partnership with cancer specialists, people living with breast cancer
experience reduced symptoms, better communication and psychological and spiritual
care; they also have someone to help them plan for the future. Once symptoms are
controlled, patients can get back to daily activities. People with breast cancer may
worry about how to talk to family and friends about the illness. They may also have
questions and concerns about treatment choices. Palliative care teams are highly
skilled in communicating with patients and their families and can be very important in
helping everyone involved match their goals with their treatment options. They will
also help you navigate the health care system and anticipate future issues that may
arise. Members of the palliative care team are also there for you to talk to about
depression, anxiety and worries about body image and sexuality. Palliative care teams
provide support not only for patients but also for their families, who also experience
distress in the face of the illness. Feeling supported by palliative care specialists,
family members are more able to support to their loved ones. Palliative care can take
place in the hospital, in an office or clinic and sometimes at home. It will improve the
quality of life of anyone living with breast cancer.
5) Palliative treatment for pancreatic cancer
Pancreatic cancer is cancer of the pancreas gland. There are different types of
pancreatic cancer. The most common type of pancreatic cancer occurs in the ducts that
transport the pancreatic juices. This is called exocrine pancreatic cancer. A more rare
type of pancreatic cancer is in the cells that make hormones. This is called endocrine
or islet cell pancreatic cancer. Pancreatic cancer can have many causes. Risk factors
include smoking and being over 45 years of age, as well as having chronic
inflammation of the pancreas, cirrhosis of the liver, obesity, long-term diabetes, or a
family history of pancreatic cancer or certain other genetic disorders. Other causes
include a high-fat diet and long-term exposure to certain chemicals. When pancreatic
cancer first starts, there are often no symptoms. As it grows, you may start to notice
changes. Jaundice is one of the first symptoms you may notice. Most people have
severe abdominal or back pain as the tumor grows. When you have pancreatic cancer,
you often experience intense pain as the tumors invade nerves and potentially spread
to other places in the body. Pancreatic cancer symptoms can change quickly. The pain
can get worse over the course of the disease. Since palliative caregivers are experts at
treating pain, they can prescribe whatever treatments will be the most effective, such
as traditional pain medications, steroids or nerve blocks. They work with you to adjust
your medicines in order to make you as comfortable as possible with the fewest side
effects. Treatments for pancreatic cancer include chemotherapy, radiation therapy and
targeted therapy. Targeted therapy is a drug taken orally that interferes with specific

11. parts of cancer cells, and blocks the growth and spread of pancreatic cancer. If you
have an early stage of pancreatic cancer, surgery may be an option. For cancer that’s
spread beyond the pancreas and cannot be cured, chemotherapy, radiation and other
types of therapies are used not to cure, but to extend life. For the most benefit, a
palliative care team should be brought in at the first diagnosis to start and ease
discussions with you and your family about your goals for care. Palliative care
specialists will objectively explain the pros and cons of each treatment. They’ll tell
you about the possible side effects, when they are likely to occur, and what can be
done to prevent or relieve them. Once your treatment is complete, you’ll be tested
regularly by your doctor to see if the pancreatic cancer has returned or spread.
6) Palliative treatment for colon cancer
Colon cancer and its treatment can cause numerous physical symptoms, including
tenderness and pain related to surgery. Since your body is unable to eliminate waste
normally, you can also experience serious bowel blockages and impactions. Bowel
blockages can be potentially life-threatening and may require additional surgery. The
most common treatment is to create a surgical opening, called an ostomy, in the skin
that allows the waste to be diverted and removed from the body. This can be both
physically and mentally distressing and impact your overall self-image and quality of
life. Your palliative care team will use a variety of methods, including diet and
nutrition, managing fluid and electrolyte balance, and medical therapies to relieve your
pain and other physical and emotional symptoms. The palliative care team is there to
be your advocate. They will help you clarify your treatment goals and assist you in
making decisions and communicating with your family and health care providers.
7) Palliative treatment for prostate cancer
Prostate cancer can cause problems with urination. You may feel the need to urinate
all the time or have trouble urinating. You may have a weak or interrupted flow of
urine, difficulty starting or stopping urination, and painful or burning urination. You
may experience other symptoms too. These prostate cancer symptoms can include pain
in the lower back, hips, or upper thighs; difficulty having an erection; pain with
ejaculation; and blood in the urine or semen. Early prostate cancer, however, does not
usually cause symptoms. Your doctor will perform several tests to detect prostate
cancer. After first performing a physical exam, your doctor will give you a PSA blood
test. Other tests may include an ultrasound, x-ray, CT scan, MRI or biopsy. There are
several options for treating prostate cancer. In the early stages, it may be removed with
surgery; but if the tumor is too large, or too close to any set of nerves, surgery may not
be an option. Radiation therapy and hormone therapy may also be used to treat prostate
cancer. If it is at an early stage and growing slowly, you may have the option of
watchful waiting. Palliative care specialists will explain to you all your different
options, and then help you to make an informed choice. They do this by helping you

12. to match your treatment options with your personal needs and goals. They will spend
a great deal of time with you to ensure that you and your family fully understand your
disease. Palliative care specialists are experts in treating the symptoms of a serious
illness like prostate cancer. Bone pain, for example, is common with prostate cancer
Palliative care specialists can help you boost your energy by adjusting hormone levels
with medicines, and suggesting specific exercises and other lifestyle changes.
Common prostate cancer side effects, such as incontinence and loss of sex drive, are
often hard to deal with. They may affect your self-esteem and create anxiety for both
you and your loved ones. Your palliative care team will help you to discuss your
situation with your family, to help ease any emotional issues that may be related to
side effects.
8) Palliative treatment for gallbladder cancer
Palliative care is treatment used to help control or reduce symptoms caused by cancer.
It's not meant to cure the cancer. If gallbladder cancer has spread too far to be removed
by surgery, doctors may focus on palliative treatments. For instance, pain medicines
and drugs to control nausea or itching might be used to help you feel better Radiation
and chemotherapy can also be used to help relieve problems caused by the tumor(s).
Sometimes, surgery or other treatments are used to help you feel better or to help
prevent problems the cancer might cause. Because gallbladder cancers tend to grow
and spread quickly, doctors try to use palliative therapies that are less likely to have
unpleasant short-term side effects, whenever possible. Your cancer care team will talk
with you about the pros and cons of all the treatments that might help you.
Benefits of palliative treatment
Improves communication between patients, caregivers, and healthcare providers.
Addresses the needs of caregivers as they cope with and care for a loved one with a
serious illness.
Offers psychological and spiritual care.
Develops a support system to help the patient live as actively as possible.
Improves patient and family satisfaction with care.
Improves quality of care while reducing costs.
Enables patients to remain comfortable by preventing and relieving pain and suffering.
Allows patients to maintain connections to family and friends.
Fosters vitality and independence in patients.
Assists with navigating the healthcare system, including putting together and advance
directive.

13. Conclusion:
Cancer is the second leading cause of death in the USA and accounts for one in four
patient deaths annually. Patients who present with advanced, metastatic disease can
have disease control for a period of time with chemotherapy and other disease-
directed interventions. However, the duration of disease control is variable, and most
patients develop progression of their cancer that leads to their death within weeks,
months or years. Patients with advanced cancer often have significant symptom
burden, including dyspnea, pain, nausea and fatigue that can cause distress and
decreased quality of life. Care that is aimed at control of symptoms whether from the
cancer itself or the toxicity of treatment delivered concurrently with disease-directed
therapies, is a key feature of patient-centered care. Early focus on care aimed at
improving QOL has been shown to improve patient satisfaction, reduce
depression and anxiety, and lead to care more consistent with patient preferences. In
addition, early focus on such care may improve survival and reduce overall costs of
care
End-of-life setting when the disease is no longer able to be controlled.

14. References
1. https://getpalliativecare.org/whatis/disease-types/
2. https://www.who.int/news-room/fact-sheets/detail/palliative-
care
3. https://www.slideshare.net/jalyjo/palliative-care-35029687
4. https://www.incb.org/documents/Narcotic-Drugs/Technical
5. https://www.cancervic.org.au/cancerinformation/treatments/t
reatmentstypes/palliative_care/palliative-care-
treatment.html
6. https://en.wikipedia.org/wiki/Palliative_care