What is Palliative and Supportive Care

Palliative and supportive care

Cancer usually affects the life of the individual diagnosed with cancer as well as the family and is accompanied by multifaceted personal, social, physical, psychological, spiritual and economic crises. Conventional cancer therapies (such as chemotherapy, radiation therapy, and surgery), focus solely on increasing the patient’s life expectancy, regardless of the “quality of life” and no less importantly, the “quality of death”.

“Palliative and supportive care” is defined as an approach with a different philosophy from the traditional approach of “disease treatment”; An approach that considers the community and the health system responsible not only for saving the patient’s life and increasing the patient’s lifetime, but also for the patient’s quality of life and the quality death, as well as the quality of life of the family and the caregivers. Palliative and supportive care achieves this by means of comprehensive multidisciplinary services, with emphasis on physical, psychological, social and spiritual dimensions of the disease.

Attitude of the World Health Organization (WHO)

The World Health Organization defines supportive and palliative care as an approach that improves the quality-of-life of the patient and their families in the face of problems caused by life-threatening diseases. These cares identify and control the physical, psychological, social, and spiritual challenges of the patient and family. On the other hand, the World Health Organization identifies prevention, early detection, treatment, and supportive and palliative care as key components in cancer control.

In general, the attitude and activity of supportive and palliative care is defined as follows:

• Relieves pain and other annoying symptoms of the disease and treatment;
• Values ​​life and considers death as a natural process;
• Neither hastens nor postpones death;
• Includes psychological and spiritual care;
• Its purpose is to create an opportunity for the patient to live an active life until the last moment of life;
• Supports the patient’s family during the patient care and continues even after patient’s death;
• Strives to respond to all needs of the patient and the family with a team approach (including counseling on death and grief (
• Improves the patient’s quality of life and family and may also have a positive effect on the patient’s life expectancy and its complications;
• Can help the patient from the beginning of the illness and along with the curative treatment approaches, such as chemotherapy and radiation therapy;
• Includes examinations needed to better understand and manage the symptoms and complications of the disease and its treatment.

Supportive and palliative care is provided with the aim to increase the quality of life of the patient and his or her family initiating from the moment that cancer is diagnosed, to reduce the patient’s physical and mental suffering and complications of treatment and elevate the patient and family satisfaction. Supportive and palliative care is not an alternative for therapeutic care, but plays an important role as a complement to the such therapies. Numerous studies have confirmed the significant impact of supportive and palliative care on increased treatment response and recovery of the cancer patients.

The World Health Organization defines health in four dimensions: physical, mental, social, and spiritual. Therefore, supposedly there is no challenge to the patient and family with the illness that is beyond the scope of palliative care. The World Health Organization considers supportive and palliative care as an urgent need of the patients with a serious illness, especially those with cancer. Despite the confirmed necessity of worldwide access to palliative and supportive care, unfortunately the provision of these cares is nascent in many developing countries, including Iran.

The right time for palliative and supportive care

Contrary to traditional view, palliative and supportive care is not limited the advanced phases of the disease. palliative and supportive care is appropriate for the patients in any stage of the disease and is best effective if initiated for the patient and family early in the course of the disease; preferably within 2 weeks from the time of diagnosis. The care continues during the various stages of the disease and beyond that, during the survivorship and supports the family after the death of the patient in advanced cases.

Relationship between supportive and palliative care and curative care

Therapeutic care is provided considering solely the promotion of the patient’s life expectancy, while the main purpose of supportive and palliative care is to improve the quality of life and quality of death of the patient and also increase the quality of life of the patient’s family through comprehensive management of the challenges posed by the disease from the time of diagnosis, parallel to the treatment and beyond the completion or cessation of the treatment.

Target population in supportive and palliative care

Palliative and supportive care targets three main population groups including:

• The first group refers to the patients with chronic diseases who their disease exerts a significant impact on their quality of life. Although the most important members of this group are cancer patients, in fact, any chronic disease that is associated with a significant decline in patient quality of life, needs for supportive and palliative care.
• The second group of the target population of supportive and palliative care refers to the caregivers and the families of the patients. It is necessary to support relatives and caregivers of the patient as active members of society whose lives have undergone fundamental changes in various psychological, spiritual, social and economic dimensions due to cancer.
• The third group of the target population of supportive and palliative care, are the staff who contact directly with patients with a serious illness. Obviously, the burnout of staff working in the field of cancer is greater than many areas of activity in the field of health and it is necessary to provide special care for them.