Abstract
Palliative care has primarily addressed the needs of patients with cancer during their last days of life. Indeed, in one country, it is mandated that formal hospice programs can only enroll patients who are expected to die within 6 months. The model wherein palliative care works only with cancer patients and their families towards the end of the patients’ existence is not logical, and may be expected to change dramatically over the next 10 years. Data from the SUPPORT study [1] clearly indicate that aspects of suffering common to cancer are also uniformly noted in patients dying of other advanced chronic disorders. Moreover, symptoms at the end of life have their genesis earlier in the course of illness. For a number of these symptoms, including pain, the cachexia—anorexia syndrome, and delirium, evidence exists [2–5] that early diagnosis and impeccable management may prevent or alleviate the full flowering of a devastating symptom. Logically, the myriad psychosocial problems that come to the fore during the course of illness should also be recognized and addressed before the end stage of an illness.
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