Editor—Williams et al and Russon and Alison raise important debates about extending palliative care beyond the initial remit of cancer.1,2 The example of anorexia nervosa in their debate is a rare example of a potential role for palliative care. But good evidence suggests that people with progressive circulatory and neurological disorders have problems that require a palliative approach.3
Palliative care is an active approach to managing the whole patient and family and their problems which applies to many conditions. The potential numbers of people with these conditions far exceed those of people with cancer. Although pain is slightly less prevalent in the last year of life in these conditions than in cancer, breathlessness, constipation, and many other symptoms and family needs are equally or more common.4
Although the Calman Hine recommendations include the development of palliative care in cancer centres, palliative care in other settings is as important. What is required to take this forward? Firstly, a better understanding is needed of the problems that patients and their families experience towards the end of life and of the likely effective treatments. For some patients a dual approach to care needs to be adopted, with the possibility of death being acknowledged and discussed while efforts are continued to preserve or lengthen life. A better understanding of prognostic indicators would aid this process. Secondly, specialist palliative care services need to widen their brief so that they can include patients with conditions other than cancer. Such a step may require resources and the development of working relationships and collaboration with those who work in other specialties.
The National Council for Hospice and Specialist Palliative Care Services has recently prepared evidence to encourage such a step.5 A challenge for medical professionals is to develop mechanisms of providing specialist palliative care on the basis of need rather than diagnosis.
References
- 1.Williams CJ, Pieri L, Sims A. Does palliative care have a role in the treatment of anorexia nervosa? We should strive to keep patients alive. BMJ. 1998;317:195–196. doi: 10.1136/bmj.317.7152.195. . (18 July.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Russon L, Alison D. Does palliative care have a role in the treatment of anorexia nervosa? Palliative care does not mean giving up. BMJ. 1998;317:196–197. . (18 July.) [PubMed] [Google Scholar]
- 3.McCarthy M, Lay M, Addington-Hall JM. Dying from heart disease. J R Coll Phys Lond. 1996;30:325–328. [PMC free article] [PubMed] [Google Scholar]
- 4.Cartwright A. Changes in life and care in the year before death 1969-1987. J Public Health Med. 1991;13:81–87. [PubMed] [Google Scholar]
- 5.Addington-Hall JM. Reaching out: specialist palliative care for adults with non-malignant disease. London: National Council for Hospices and Specialist Palliative Care Services; 1998. [Google Scholar]