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The podcast emphasizes the crucial and often misunderstood role of palliative care, particularly for older adults battling cancer. It clarifies that palliative care is not solely end-of-life support but a proactive, holistic approach introduced at any stage of illness to improve quality of life by managing symptoms and providing comprehensive physical, psychological, social, and spiritual support. The podcast highlights how palliative care addresses the unique complexities faced by older patients, such as multiple health conditions and social isolation. Ultimately, it asserts that early integration of palliative care leads to better outcomes, including enhanced well-being and, remarkably, potentially extended survival, debunking the misconception that it's a "surrender" to disease.
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0:10
Welcome to the deep dive. Today we're uh
0:12
tackling a topic that's deeply personal,
0:14
really touches so many lives,
0:16
especially, you know, as the world's
0:17
population gets older. We're talking
0:18
about navigating serious illness,
0:21
specifically cancer and older adults.
0:23
But, um, here's the thing. Right off the
0:25
bat, we want to challenge a really
0:26
common idea, one that's actually pretty
0:28
damaging. You've probably heard it,
0:30
maybe even thought it that paliative
0:32
care that's just for the very very end
0:34
of life like hospice, right? Well, the
0:36
sources we've looked at paint a
0:37
completely different picture, much more
0:39
dynamic and honestly a lot more hopeful.
0:42
So, our mission today is to unpack what
0:44
palative care really is, why it's not
0:46
just, you know, a nice to have, but
0:48
absolutely essential for older adults
0:50
facing cancer. And we'll get into some
0:52
pretty compelling evidence, some
0:54
surprising science about just how big
0:55
its benefits can be. The goal is for you
0:57
to walk away really understanding this
1:00
vital field, maybe seeing it in a whole
1:01
new light. Okay, so let's just get this
1:03
out there first. That idea that palative
1:05
care means giving up or it's only for
1:07
the last days or weeks. It's so
1:09
widespread.
1:10
It really is and it causes so much
1:11
misunderstanding. The actual definition
1:14
well palative care is a specialized
1:16
medical approach. It's intensely focused
1:19
on giving relief. Relief from symptoms,
1:21
from the stress, the burden of serious
1:23
illness. The main goal, improve the
1:25
quality of life for the patient, yes,
1:28
but also for their family. And here's
1:30
the crucial bit you mentioned. It's
1:32
often delivered seamlessly alongside
1:34
curative treatments. They happen
1:36
together,
1:36
right? That's such a massive difference.
1:38
So, it's not about like throwing in the
1:40
towel at all. It's more about making
1:41
every day better, even while you're
1:43
actively trying to cure the cancer. That
1:45
feels Yeah. Incredibly proactive.
1:47
Precisely. Proactive is a great word for
1:49
it. And it's holistic. Truly, it looks
1:52
at the whole picture. Physically, yes,
1:54
it tackles things like pain, which can
1:56
be debilitating, uh, nausea, that awful
1:58
fatigue, shortness of breath,
2:00
what doctors call dysmia. But it goes
2:02
way beyond just the physical symptoms.
2:04
It provides really crucial support for
2:06
psychological distress, too. Things like
2:08
anxiety, depression, even that deep um
2:11
existential angst that can hit you with
2:13
a cancer diagnosis. And then there's the
2:15
emotional, social, and even spiritual
2:17
support. These paliative care teams,
2:19
they're interdisciplinary. They act as
2:20
guides. They help patients sort through
2:22
complex medical decisions, really
2:24
understand their prognosis, and
2:26
crucially make sure the treatment
2:27
choices line up with their personal
2:29
values, their priorities, what matters
2:31
most to them in life.
2:32
Okay, so just to be crystal clear on the
2:34
timing, because that seems key. This
2:35
isn't something that just comes in at
2:36
the 11th hour. This support system, it
2:39
can be introduced really at any stage of
2:41
a serious illness, like from day one.
2:43
Absolutely. From the moment of diagnosis
2:46
right through active treatment into
2:47
survivorship. And yes, if the illness
2:49
progresses that way through the end of
2:51
life phase as well, it's a continuum.
2:53
A true continuum.
2:54
It really is. And the aim always is to
2:57
optimize overall well-being and function
3:00
to empower patients to live as fully, as
3:03
comfortably, and you know, as
3:05
meaningfully as possible for however
3:07
long that may be. It's about maximizing
3:09
life.
3:09
Okay, so that makes sense conceptually,
3:11
but let's dig into the specifics for
3:13
older adults with cancer. Why is this
3:16
approach particularly vital for them?
3:18
what makes their situation um uniquely
3:21
challenging?
3:22
Well, it's really interesting there
3:23
because older adults face this complex
3:25
interplay of factors. It's often not
3:26
just the cancer. Many older adults have
3:29
multiple pre-existing health conditions
3:30
already. You know, heart disease,
3:32
diabetes, arthritis, things like that.
3:34
We call them coorbidities. These can
3:36
really complicate the cancer treatments
3:38
themselves and they add their own
3:40
symptom burden on top of everything
3:41
else.
3:41
Right. So, it's layered.
3:42
Exactly. Then there's polyfarm pharmacy.
3:44
That just means taking multiple
3:46
medications at the same time. It's super
3:48
common in older adults and it ramps up
3:50
the risk of side effects, bad drug
3:52
interactions and you also have age
3:54
related physiological changes, maybe
3:56
some functional decline, sometimes
3:58
cognitive impairment. These can make
4:00
delivering cancer treatment trickier,
4:02
make symptoms worse, or even affect
4:04
someone's ability to sort of manage
4:07
their own care or make decisions.
4:09
H that makes sense.
4:10
And one more thing, unfortunately, is
4:12
social isolation. Oh,
4:13
it's a tough reality for many older
4:15
people and it can really amplify
4:17
psychological distress, limit practical
4:19
support and even get in the way of clear
4:21
communication with their doctors. It's a
4:23
whole web.
4:23
Wow. Yeah, a whole web is right. It's
4:26
not just the disease, it's the person's
4:27
entire context. So given all that
4:30
complexity, how are paliative care
4:32
teams, you know, specially equipped to
4:33
handle that? What's their unique skill
4:35
set?
4:36
That's exactly where they shine. They
4:38
are trained to provide these highly
4:39
tailored interventions. They
4:41
meticulously consider everything. The
4:43
patients overall health, their social
4:45
situation, cultural background, their
4:47
very personal preferences. They
4:49
consistently focus on the whole person,
4:51
their life, their values, their fears,
4:54
their hopes, not just the cancer cells.
4:56
And by doing that, they help ensure that
4:58
the treatment plan isn't just medically
5:00
sound, but it's also realistic for that
5:02
person, sustainable.
5:04
Yeah.
5:04
And genuinely align with what they want
5:06
out of life, their broader goals. So it
5:09
really respects the individual within
5:10
the illness.
5:11
Precisely. And that person- centered
5:13
approach, it fosters a real sense of
5:15
dignity and control too, even when
5:17
things feel overwhelming.
5:18
Okay, let's shift to the impact then
5:20
because you hear about early paliative
5:21
care and the evidence seems well pretty
5:25
remarkable, sometimes even
5:26
counterintuitive.
5:27
It is transformative and the data is
5:29
strong now. High quality studies
5:31
consistently show integrating
5:33
paliotative care early on leads to first
5:36
significantly better symptom control
5:38
just feeling better day-to-day. Second,
5:41
a demonstrably improved quality of life
5:43
and not just for the patient but for
5:45
their caregivers too who carry a huge
5:47
load. And third, a notable reduction in
5:50
things like unplanned hospital trips,
5:52
emergency room visits. Those are
5:53
stressful, disruptive and costly,
5:56
right? And wasn't there a landmark study
5:58
I think teml at all back in 2010 in the
6:00
New England Journal of Medicine? That
6:01
one seemed to really make waves.
6:03
Oh, absolutely. That study was pivotal.
6:05
It really shifted perspectives. They
6:07
looked at patients with advanced lung
6:08
cancer, specifically metastatic non
6:10
small cell lung cancer. And the patients
6:12
who got early palative care alongside
6:14
their standard cancer treatment, well,
6:16
they reported less depression,
6:18
significantly better quality of life
6:20
than you might expect. But here's the
6:22
kicker. Remarkably, they also lived
6:25
significantly longer than the patients
6:26
who only got the standard oncology care.
6:28
Okay, wait. Lived longer just by getting
6:30
care focused on quality of life and
6:33
symptoms earlier. That's that's the head
6:35
turner, isn't it? It feels paradoxical.
6:37
It does initially,
6:38
but it points to a critical truth. When
6:41
you focus intensely on enhancing quality
6:43
of life, on managing symptoms
6:45
proactively, providing that whole person
6:47
support, it can actually enable patients
6:50
to tolerate their cancer treatments
6:52
better. maybe stay on them longer. It
6:54
helps them maintain their functional
6:55
status, avoid those debilitating
6:57
complications that can really shorten
6:59
lifespan.
7:00
So, managing the side effects and the
7:02
stress actually helps them fight the
7:03
cancer more effectively in a way
7:05
in a very real way. It's this powerful
7:07
idea that living well can genuinely
7:09
contribute to living longer. It's not
7:11
just about adding days to life, but life
7:13
to days and sometimes that adds more
7:15
days too,
7:16
which really reinforces this idea you
7:17
mentioned earlier. Paliotative care
7:19
isn't an end point. It's more like like
7:21
a bridge supporting people throughout
7:23
their journey.
7:24
Exactly. That's a perfect analogy. It's
7:26
a continuous spectrum of support, a
7:28
robust compassionate bridge. It's not
7:31
some cliff you fall off when curative
7:33
options dwindle. And that bridge adapts
7:35
right from diagnosis. Paliotative care
7:37
can help manage treatment side effects,
7:39
make communication with the oncology
7:40
team clearer, more empathetic, help plan
7:43
for future care needs as things evolve.
7:46
So the focus might shift over time but
7:48
the support is constant.
7:49
Precisely. The intensity might change,
7:52
the specific interventions might adjust
7:54
based on the disease or treatment goals.
7:56
But that fundamental commitment to the
7:58
patients comfort, their dignity,
8:00
optimizing their quality of life that
8:02
remains unwavering. That's the core
8:04
mission.
8:05
And ultimately that empowers people,
8:07
right? Mhm.
8:08
Older adults with cancer get to keep
8:10
their autonomy, make informed choices
8:12
that are right for them, and find ways
8:13
to live with purpose, with meaning, no
8:16
matter what the scans say or what stage
8:18
they're at.
8:19
Yes, it really champions the idea that
8:21
every single day matters and every day
8:23
deserves to be lived with as much
8:24
comfort and dignity as possible.
8:26
So, as we start to wrap up this deep
8:27
dive, the takeaway message seems
8:29
incredibly clear. Paliative care is well
8:33
it's essential but it's often tragically
8:35
underused especially for older adults
8:37
with cancer yet by offering that
8:40
holistic symptom management that
8:42
psychosocial support that expert
8:43
communication it just profoundly
8:46
improves the whole experience for
8:47
everyone involved.
8:48
It really does and we absolutely have to
8:50
keep working to dispel that damaging
8:52
myth that misconception that it's only
8:54
for the very end. The evidence is just
8:55
too strong now. Early integration
8:57
alongside curative care leads to
8:59
measurable improvements, better quality
9:01
of life, less suffering from symptoms,
9:03
and yes, in some cases, even longer
9:05
survival. It's not wishful thinking.
9:07
It's documented.
9:08
Which leaves us with a final thought for
9:10
you, our listeners, to really chew on.
9:13
Advocating for early, routine, paliative
9:15
care and cancer treatment for older
9:16
adults. Is it just about being
9:18
compassionate or is it actually
9:20
fundamental to delivering the highest
9:21
possible standard of care? truly
9:23
patient- centered, holistic, effective
9:25
healthcare. It makes you reconsider,
9:27
doesn't it? What does success really
9:28
mean when we're facing serious illness?
9:30
Something to think about.
#Health
#Aging & Geriatrics