Palliative Treatment Considerations for Colon Cancer

Comfort Care for Advanced Metastatic Colon Cancer

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Palliative treatment, also known as symptom management or comfort care, is focused on subduing uncomfortable symptoms from a chronic or terminal disease. In colon cancer, palliative treatment can help you cope physically, emotionally and spiritually during your fight.

When people receive palliative treatment, the medications, procedures or surgery elected are intended to help with symptom management, as opposed to providing a cure for the cancer.

An easy way to understand palliative treatment: If you have a sore throat, you may take a lozenge. The lozenge is palliative -- it does not "cure" the cause of the sore throat, but it does relieve the symptom of discomfort.

Palliative care is not hospice care -- although hospice uses palliative care measures to maintain comfort and symptom relief. You have probably been receiving palliative care from the start of your cancer treatment without even knowing the symptom relief you were experiencing had a name.

Palliative Treatment Focuses on Comfort

Regardless if you have just been diagnosed with advanced metastatic colon cancer or if you've already undergone rounds of treatment, palliative care measures may focus on relieving common symptoms and sources of discomfort, including:

  • Anxiety, depression and confusion
  • Anemia, shortness of breath and fatigue
  • Anorexia and weight loss
  • Constipation, diarrhea and bowel obstruction
  • Lymphedema
  • Nausea and vomiting
  • Pain management
  • Sexuality concerns

Treatments Aimed at Comfort, Not Cure

There are many reasons why people with advanced cancer elect palliative care over curative treatment. Sometimes, the decision is within your control, such as when you choose to decline surgery or another form of curative treatment.

However, symptom management may be your only viable option if your physical health, age or concomitant medical problems could not withstand aggressive, curative treatment for the cancer. Although there are many different palliative treatment options available, those most commonly used to control advanced, incurable colon cancer include:

  • Chemotherapy
  • Radiation therapy
  • Palliative surgical interventions
  • Pain management
  • Pharmaceutical use

Chemotherapy as Palliative Treatment

Based on your physical health, metastases and prior treatment history, your oncologist will work with you to develop a palliative chemotherapy treatment plan. Unlike chemotherapy intended to cure cancer, palliative chemotherapy treatment is focused on providing relief from symptoms, such as pain, by shrinking the tumors or keeping them stabilized (no further growth).

Most commonly, a regimen involving 5-FU, Adrucil, Efudex, or Fluoroplex (fluorouracil) is used either alone or in combination with another chemotherapy drug. Clinical studies for palliative care regimens are ongoing as the National Cancer Institute aims to find a combination that can stabilize or shrink tumors without causing additional side effects and discomfort.

Radiation Therapy as Palliative Treatment

Similar to chemotherapy, radiation therapy is used to shrink pelvic tumors and control pain relief when used as a palliative treatment option. This treatment option works especially well for people suffering from pain due to pelvic nerve invasion (when the cancer spreads through the nerves in your abdomen and pelvis). Although it works best for localized tumors, radiation therapy may help eliminate or decrease severe bleeding from advanced metastatic colorectal tumors.

Surgery for Palliative Treatment

Surgical removal of part (or all) of the cancer and metastases is not always aimed at curing the disease. Surgery is labeled as "palliative" when the end goal is to make you comfortable, not cure your cancer. To promote and maintain your physical comfort, the surgeon may need to physically cut and reduce the size of the tumor to reverse tumor invasion into neighboring organs (bladder, stomach, vagina), open the bowels and correct an obstruction, or even cauterize a large bleeding tumor. Palliative surgical options may be:

  • Major – completely opening the abdomen to remove part (or all) of a tumor.
  • Laparoscopic – less invasive, smaller incisions used to laparoscopically remove portions or entire tumors.
  • Local – local excisions are minimally invasive for the elderly, very ill, or any person that cannot tolerate general anesthesia for a major or laparoscopic surgery.
  • Laser – can be used endoscopically to control rectal and left sided-tumor bleeding.
  • Stent – a bowel stent can be placed endoscopically to hold the colon open around a large tumor, maintaining a pathway for stool to exit. Can be elected in place of open surgery for bowel obstruction (which may end with a colostomy).

Your surgeon will take many factors into consideration before presenting your palliative surgical options to you, but most important is your treatment goal. You will need to decide what you want to accomplish through surgery and discuss all concerns thoroughly with your surgeon. Surgery, no matter how non-invasive, is not without risks. Prior to electing a palliative surgical intervention, you will want to discuss your advanced directives with your doctor and family. The surgeon needs to be aware of your end-of-life choices (do you want cardiopulmonary resuscitation should you need it? Artificial feeding?) prior to operating on you.

Pain Management

Pain management is a top priority in palliative care. You can receive pain management from your primary doctor, oncologist or even a pain management specialist. Interventions to alleviate or control your cancer pain may include:

  • Pain medicines (prescription, over-the-counter drugs and complementary medicines)
  • Tricyclic antidepressants or anticonvulsants (for nerve-based pain)
  • Interventional procedures (epidurals, nerve blocks)
  • Physical or occupational therapy
  • Counseling and biofeedback

In advanced colorectal cancers, the most commonly prescribed pain medicines are the opioid drugs, which include morphine. Suffering from cancer pain is needless and does not serve any purpose. Your doctors are trained to anticipate and treat pain from the primary tumor, metastasis, and potential complications from the tumors and treatment (lymphedema).

Your healthcare team will frequently inquire about your pain status. The most commonly used way to rate your pain is by using a 0-10 numeric scale, where 0 represents no pain and 10 represents the worst pain you have ever endured. Since pain is a subjective symptom (there is no way to measure what you perceive), this is currently the best method of assessment.

Pharmaceutical Use

Aside from pain management, many symptoms can be controlled or alleviated through prescription medications. Your oncologist can prescribe medications to help reduce nausea, increase appetite and even boost your energy. Talk to your doctor about these symptoms, so that he or she can work with you to develop a palliative treatment plan tailored to you and you alone.

Sources:

American Cancer Society. (2006). American Cancer Society's Complete Guide to Colorectal Cancer. Clifton Fields, NE: American Cancer Society.

Dixon, M.R. & Stamos, M.J. (2004). Strategies for Palliative Care in Advanced Colorectal Cancer. Digestive Surgery: 21. Accessed April 17, 2012 at DOI: 10.1159/000081351.

National Cancer Institute. (n.d.). Palliative Care in Cancer. Accessed April 17, 2012.

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