The treatment of any potentially deadly condition carries with it for most people an element of hope – that the treatment will be a success, they’ll regain their good health and that they’ll live for many more years.
Sadly, of course, for some, that’s not the outcome. Instead, they and their family must deal with a barrage of emotions as the patient makes the difficult transition from active treatment to palliative care.
Dr Ralph McConaghy, is a palliative care specialist who helps patients and their loved ones navigate this journey, says the end of active treatment is a devastating moment for most people who are fighting cancer.
“They have a conversation with the oncologist, who says there’s no more treatment we can offer you to fix this cancer, so it’s going to progress and it will end your life,” he says. “Quite often the patient feels like ‘you’ve put me in a row boat, untied me from the jetty, pushed me into the ocean and I’m sailing away by myself’.”
Dr McConaghy works as part of Icon’s team to ensure that that’s not the experience of Icon’s patients, where there’s a gentle transition and ideally overlap between oncological and palliative care.
Icon specialises in providing cancer treatments, including chemotherapy, radiation therapy and hormone treatments that can be used to cure the cancer. If this isn’t possible, then such treatments may prolong life or possibly minimise symptoms in patients with terminal conditions.
Embracing end-of-life care
Dr McConaghy doesn’t deny, though, that a patient’s first appointment with him can be scary.
“I usually say to people, ‘You’re probably anxious that you’ve met me’ because likely the only thing they know about palliative care is that they might meet a doctor like me only in the last one or two weeks of their life,” he acknowledges.
But palliative care is about so much more than managing pain at life’s end, he says.
“My job here is to help you live as well as you can until the end of your life,” Dr McConaghy says he tells patients in his care. “I can’t tell you when that’s going to be, but in the meantime, how can I help you achieve your goals, live as well as you can, support you and your family so that life is as good as it can be?”
This can involve ensuring the patient and their family have access to the array of support services available, including local care providers, support groups and non-profit organisations such as the Leukaemia Foundation and Cancer Council.
As well, there’s a free service provided by the government called PalAssist that provides 24/7 phone and online support to people with life-limiting illnesses and their families, and Dr McConaghy also recommends CareSearch, an online resource centre for people exploring end-of-life issues.
In addition to providing emotional support and information, palliative care is about managing any physical impact from the patient’s condition.
“I’ll just say to them, ‘I’m good at helping people with pain and other symptoms, so why don’t we talk about what’s causing your distress and let’s see if it can be improved it’ and usually it can,” Dr McConaghy explains. “I’ll meet them again two weeks later and they’ll say, ‘I feel much less pain, why didn’t I see you six months ago?’ and that’s a common comment.
“We’ll build a relationship and talk about the scary stuff as time goes by.”
Some of that ‘scary stuff’ involves helping patients ready themselves for the end-of-life journey at a time when they’re mentally prepared to have that conversation.
“We might ask if their will is done, have they done a power of attorney, do their partner, children or parents understand where they’re at in the disease process and if they have questions about how they are,” Dr McConaghy says. “It’s a gradual thing and we try to be gentle.”