Introduction

Palliative and supportive care is integral to providing excellent care of patients with any life-threatening or life-altering disease. Patients and families now expect that they will receive attention that centres on their human as well as their medical needs. They expect that the emotional and psychological aspects of care will be recognised and addressed.

Palliative care, similar to comprehensive cancer care, is always a team effort as one clinician cannot answer the complex needs of someone at a time of crisis such as life-threatening illness.

The absolute ideal is to have palliative care specialists or a member of the gynae-oncology team with a special interest in palliative care, available from the inception of treatment, whatever the individual's prognosis. Some people will require minimal input from palliative care, while some will benefit from intense periods of input from palliative care specialists at specific points in their treatment. Others will require no direct intervention at all from specialist care. Additionally, some may benefit from discussion with the specialist palliative care team, although they will not need to be seen by them.

There is some confusion over the definitions of the terms palliative care, supportive care and end-of-life or terminal care, although they are widely used. This uncertainty can lead clinicians to wonder whether their patient is ‘ready for palliative care’ or ‘at that stage yet’. Patients themselves often share this confusion, and this may be particularly problematic in young people who are highly symptomatic but want to go on having life-prolonging treatment. They may fear that accepting palliative care is accepting psychological defeat leading to inevitable death and the end of their ‘active treatment’. This is a great shame as effective symptom control, alleviation of psychosocial distress and other problems (related to, but not necessarily caused by, the direct effects of the tumour) will provide a better quality of life, and possibly an improved prognosis.

Standard Definitions

Palliative Care

It was first defined by the WHO (1967) as ‘the active, total care of patients when the disease is no longer curable and the prognosis is short’. The complete opposite is ‘there is nothing we can do’. It involves meticulous symptom control as well as care of the patient and their family.