Palliative care” is often misinterpreted by the patient’s family ● This treatment plan aims to improve the quality of survival and is not negative, using a combination of surgery, chemotherapy, radiotherapy, biological therapy and adjuvant therapy in Chinese medicine Doctor: “Your father’s intestinal cancer has two liver metastases, so he has lost the chance of surgery and can only palliative treatment first.” Family member (excited): “We don’t accept this plan, we will not give up!” Doctor (helpless): “We are not giving up on him.” Family member (disbelief): “Then why ‘palliative care’, can’t we use a more aggressive treatment method?” In the oncology department, similar doctor-patient conversations are staged almost every day. In the eyes of many family members of advanced cancer patients, when doctors decide to adopt “palliative care”, it is almost the same as declaring that there is no hope for the patient to be treated, leaving the patient to his or her own fate. As a result, families are very resistant to palliative care. In fact, this is a misunderstanding of palliative care. Oncologists point out that palliative care can also make a difference, not only improving the patient’s quality of survival, but also helping to extend the survival time. In individual cases, it can even create a miracle of life. According to the Chinese dictionary, the word “palliative” has the meaning of “unprincipled accommodation, indulgence, and unrestricted”. When the word “palliative” and “treatment” are paired together, many people take it for granted that this treatment will do little to help the patient and that leaving the tumor unchecked will speed up the patient’s death. “There are many misconceptions about palliative care among patients’ families. In the medical field, palliative care is relative to ‘radical treatment’ that can cure cancer, not some ‘palliative care’ or ‘passive abandonment’. ” Dr. Zhu Huaqiang of the Department of Hepatobiliary Surgery of Shandong Provincial Hospital explained that cancer treatment can be divided into three stages: The first stage, for early diagnosis and early treatment of early cancer, the principle of treatment is to work toward the goal of curing cancer, mainly by radical surgery. In the second stage, for patients who are already in the middle or late stage when they are clearly diagnosed, when the disease cannot be cured, or when they cannot receive radical surgery due to their physical condition, they can live longer and better through palliative treatment. In the third stage, when the patient’s condition is too serious to return and he or she is approaching the end of life, “hospice care” is adopted, which means that the patient’s pain is relieved by using a combination of medication, analgesia and psychological comfort, so that the patient can calmly say goodbye to his or her family and finish life. “In this sense, patients who have lost the chance to be cured can still get the chance to prolong their survival through ‘palliative care’,” said Dr. Zhu Huaqiang from the Department of Hepatobiliary Surgery of Shandong Provincial Hospital. It is not only advanced or terminal patients who can receive palliative care. Some patients are temporarily not suitable for radical surgery due to multiple complications, but they can also use palliative care first to control the rapid spread of cancer and wait for the right time to complete the surgery. “Palliative” means: more and more abundant, treatment is not negative “Some cancer patients mistakenly believe that ‘only surgery with knife is active treatment,’ and if they receive palliative care, they will not have the chance to have surgery. In fact, we often have to give patients palliative resection surgery.” Zhu Huaqiang pointed out that this kind of surgery is different from radical surgery, which mainly serves to improve the quality of patient’s survival. For example, if a gastrointestinal tumor progresses to an advanced stage, the patient cannot eat or defecate normally because the tumor grows too big and blocks the gastrointestinal tract, which is very painful. At this time, palliative resection surgery for gastric or intestinal cancer can be performed to relieve the gastrointestinal tract and improve the patient’s nutritional status. “In recent years, palliative care is becoming more and more abundant and not negative.” Zhu Huaqiang pointed out that in addition to palliative surgery, there are various means such as radiotherapy, chemotherapy, multi-path interventional therapy, combination of Chinese and Western medicine, biological therapy, psychological support and analgesia. In the past, for patients with liver and lung metastases, often only systemic chemotherapy was done, which was very damaging and ineffective. “Now for patients with recurrent liver cancer, radiofrequency ablation can be done to cauterize small recurrent lesions. The radiofrequency ablation technique is less damaging, and the patient can walk on the ground the day after surgery.” Zhu Huaqiang said that for brain and bone metastases of lung cancer, there was no effective way in the past, but nowadays, lung cancer patients with effective genetic screening can prolong their survival time through targeted drugs. As we all know, cancer pain can make patients sleep and eat uncomfortably, and even kill them alive. The rational use of analgesic drugs not only reduces cancer pain, but also helps patients to eat and sleep well, which helps to improve their immune system. While adhering to the standard anti-cancer treatment, using Chinese medicine to assist in anti-cancer, especially after chemotherapy, and using Chinese medicine to regulate the body and mind to improve the side effects of chemotherapy can also help to enhance the anti-cancer efficacy. Expert Reminder: Cooperate with palliative care Family members avoid two misconceptions How should family members support their loved ones when they receive palliative care? Doctors suggest to avoid falling into two common misunderstandings. First, do not deceive the patient that “the disease is not serious” and “it is in the early stage”. This is the most popular well-intentioned lie told by Chinese cancer families. Zhang Bei said that some relapsed patients had brain metastases and needed radiotherapy, but their families loved them so much that they lied to them that they were doing “preventive irradiation” for fear that they would not be able to bear it. When the patient found that his health was deteriorating day by day, he blamed the doctors for not doing their best and passed away with anger. Palliative care means that the patient has lost the chance to be cured and the end of his life is clear, and all the treatment now is to buy precious time for the patient to make proper arrangements for the rest of his life. At this point in time, the patient should not be kept in the dark about the progress of his or her condition, and should not be able to cooperate with the doctor’s treatment, let alone organize the “last leg of the journey” in an orderly manner. It is believed that the family members who love the patient deeply do not want their loved ones to pass away with regrets, so it is better to believe in the ability of the loved ones to withstand and return the right to know and the final choice of life to the patient. Secondly, do not believe in “folk recipes”. The clinic always see a patient’s family around to seek medical help, a thousand gold party, a sack of herbs in the end but did not save the life of loved ones, but let the patient eat enough suffering. “Some ‘miracle doctors’ have not seen the patient on the prescription of drugs, can be trusted? Isn’t it messing up to prescribe extremely potent anti-cancer Chinese medicine when the patient is undergoing chemotherapy and is weak?” Therefore, patients should trust doctors in regular hospitals and keep in mind that TCM should be used as an adjuvant treatment against cancer and should never replace western medicine in anti-cancer treatment, so as not to waste money and lives for nothing. Technology progress: palliative care is now “private customization” “Choose the most suitable treatment plan for the patient, and palliative care will create a miracle of life if the ‘time, place and people’ are available. ” Two years ago, an 84-year-old patient with intestinal cancer was admitted to the hospital due to three metastases in the liver. The elderly man had poor heart function and could not tolerate surgery. The doctor told him to have six courses of chemotherapy first. Fortunately, the old man was sensitive to the drugs and the tumor shrank significantly. Doctors judged that he had a chance for radical surgery and mobilized him to undergo the operation. “The old man is too old to tolerate surgery in common sense. If the family does not let go of the tumor, then it is likely that the old man’s tumor will come back after stopping the medication.” Zhu Huaqiang said that the old man trusted the doctor and actively cooperated with him during the treatment. Eventually, he chose to undergo surgery to remove the tumor from his liver and intestines. After the surgery, six more courses of consolidation chemotherapy were done. By a miracle, the old man’s tumor markers dropped to normal levels during the post-operative review, and no tumor was detected in his body, and he has now passed two years peacefully. Zhu Huaqiang pointed out that as cancer treatment enters the era of individualized treatment, the palliative treatment plan presents more distinctive individual characteristics. Doctors will take into account the patient’s condition, stage, physical condition, financial and psychological ability, and other conditions to make a “private order” so that the patient can get better results. For example, some patients can undergo surgery first and then chemotherapy. For some patients with oversized tumors, chemotherapy can be used to shrink the tumor first, and then surgery can be performed if appropriate. If chemotherapy is administered and the tumor is insensitive or even enlarges, other means should be considered. Today, a considerable number of patients with advanced cancer are able to organize their lives and work without significant pain. Some patients have been given several months or even longer “free time” through palliative care, so that they can fulfill their long-cherished wishes and make proper arrangements to say goodbye to friends and relatives and to deal with their affairs.