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How Does Private Palliative Care Work In The 21st Century?

For anyone diagnosed with cancer, the first response, beyond the shock of being diagnosed, is the question “How can I get better?” But the answer to this question will vary widely. Some cancers are much easier to treat than others, while a key factor for any patient is how soon the condition is caught. If it is detected at an early stage, the prospects for survival are much better. Most of the time, the treatment will be less gruelling, not lead to continue for as long and, therefore, bring fewer side effects. While early diagnosis, effective treatment and then remission is the best-case scenario, there is always the opposite to consider. Although people survive cancer far more now than they used to, late diagnosis and particular aggressive types of cancer can tilt the odds against the patient. Often the first factor is crucial, such as in the case of Abi Macnamara, a woman from Swansea whose case has been in the news of late; a cancelled smear test at the start of the pandemic in March 2020 when she was told she was not a priority meant her cervical cancer was diagnosed too late and is now incurable.  

How Treatment Works At Stage 4

This is essentially the situation that is reached when a patient has Stage 4 cancer, which means the disease has spread to other parts of the body; in that case, the ultimate prognosis is not good but with the right treatment they may survive for years. Faced with a terminal situation, the issue of how private cancer treatment can incorporate palliative care is a matter that can be approached in a range of ways. A series of issues must be considered. These include the issue of at what point treatment should be reduced or even stopped altogether so a patient can avoid suffering side effects and, if hospitalised, return home for their final days or weeks in familiar surroundings and the company of their loved ones, with limited treatment such as pain relief. However, this applies to what is known as ‘end-of-life care’. Before that point is reached, many of the treatments that might have been used to fight the cancer at an earlier stage in the hope of beating it could still have a role in longer-term palliative care. These can include chemotherapy, radiotherapy, hormonal treatments, targeted drugs, surgery and more, with a range of benefits helping increase the patient’s quality of life. Cancer Research UK highlights the benefit of treatments like this including tumour shrinkage to reduce the pressure on nerves, which will mean less pain. Even if the tumour cannot be eliminated, it can still be held back.  

Not Just About Delaying The Inevitable

This may sound like a case of ‘delaying the inevitable’, but in a wider context so is everything we do to stay alive. All of us will die at some stage and as we get older millions will take medicine to prolong life and improve its quality in the face of a range of diseases. In the case of palliative care for cancer, it is about specific treatments to hold back a particular killer. Of course, there was a time when such treatment would not have been available and death would have come sooner and with far less mitigation of suffering. Now, there is much debate about just how much people should do to prolong life now the means are there to do so.  

Why Assisted Dying Debate May Be Misleading

Much of the discourse about this has centred on the argument that Britons should be allowed to deliberately end their lives early - so-called ‘assisted dying’ - as is permitted in countries such as Belgium, Switzerland and Canada. Broadcaster Dame Esther Rantzen, who has stage 4 lung cancer, has recently been campaigning for the UK to follow suit. While there are strong opinions on both sides of the debate and opinion polls show the majority of the UK public would support such a development, the debate may somewhat muddy the waters on palliative care. Arguments for assisted dying inevitably emphasise the suffering a patient will endure at the end, not how much more quality life may be possible. The fact is that there is far more that can be done to alleviate suffering for those with Stage 4 cancer than some might understand. Wider knowledge of this would not necessarily shift public opinion radically - Dame Esther will be aware of it in her personal situation and that has not been persuasive for her - but it can give much assurance for those potentially facing this situation themselves and who would rather be helped to live as long as they can than to depart sooner.

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