Palliative Care in Kidney Cancer More Than Just Relieving Symptoms

The timing for palliative care may be appropriate if patients are experiencing uncontrolled symptoms or prefer more support during treatment.

For patients with kidney cancer, understanding how palliative care can help is essential throughout the treatment process.

Palliative care, according to the Mayo Clinic, is medical care that specializes in relieving pain and symptoms associated with an illness. This type of care can also help patients cope with treatment-related side effects.

However, there’s more to palliative care than just relieving symptoms. It also “aims to help patients and families in one of three major categories,” Dr. Pallavi Kumar explained during an interview with CURE®.

Kumar is the director of Oncology Palliative Care and assistant professor of Clinical Medicine in the hematology-oncology division at the University of Pennsylvania.

She noted that the three categories of palliative care include:

• Complex symptom management, such as pain, nausea or fatigue
• Palliative care support via counseling or coping support from social workers
• Planning for the future to best provide for patients’ goals and values

Knowing When Palliative Care Is Appropriate During Kidney Cancer

Previously, palliative care was not given until treatment options ran low, which was often towards the end of patients’ lives, Kumar said. Now palliative care may be appropriate during any point of patients’ experiences with kidney cancer, but particularly when they experience uncontrolled symptoms, ask for more support or need to refocus their goals and values.

“Palliative care can often help just bring everybody together for the sake of the patient and talk about what the goals are, what the medical realities are and how we [can] align the care with the patient’s goals,” Kumar explained. “There are many opportunities to involve palliative care, but usually I'd say if things are changing and we're worried that the patient's not going to necessarily recover back to where they were, that's probably a time to refer to palliative care.”

If patients’ quality of life is affected by either their treatment or cancer, it’s also a good time to consider starting palliative care, she said.

Why Palliative Care Is Important to Consider

Visits with an oncologist may be “jam-packed” with physical exams, toxicity reviews or symptom reviews and discussions about lab results and scans, Kumar noted.

“The visit is very packed, so sometimes there isn’t time or the space in a routine visit to talk about what happens if plan A doesn't work, what plan B looks like and [whether] plan B aligns with [patients’] goals and values,” she added. “There's not often a lot of time to unpack some of those things before a crisis happens, so having access to palliative care offers another space for you to talk through what might be your goals and values.”

She emphasized that although oncologists “do a fantastic job” at explaining these goals, values and plans, sometimes going beyond their care is necessary. For example, this may include working with palliative care teams who specialize in pain or symptom management, she explained, which will help with quality of life.

Advice for Patients With Kidney Cancer Considering Palliative Care

For patients with kidney cancer who are looking to utilize palliative care, Kumar recommended asking their oncology team about it and the best time it may be useful to them. Once patients start receiving palliative care, she also suggested that patients write down questions regarding quality of life before their visit.

“Think about this well before you ever need it. Please think about the one or two people in your life who you would trust to make medical decisions on your behalf,” Kumar said. “I have a lot of patients with adult children, but no one really knows who the medical person is [or] who the financial, legal person is.

“I’d say, just designate these things very clearly and have these conversations with your loved ones, so that if anyone's ever called on to make medical decisions on your behalf, they know who they are. Please try to talk with your family about what your wishes for future care might be. Advanced care planning is the best gift you can give to a loved one, so that they're not ever put in a position where they're guessing what you might want, fearing that they chose the wrong decision for you, or making a decision you wouldn't have made for yourself.”

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