We’ve made many strides in research, treatment and even lifestyle changes, however cancer continues to have a major impact globally. “There were an estimated 14.1 million cancer cases around the world in 2012, of these 7.4 million cases were in men and 6.7 million in women. This number is expected to increase to 24 million by 2035,” according to the World Cancer Research Fund International worldwide data. The fund further notes that in 2012, the most common cancers were lung (men and women); breast (women only) and colorectal (men and women).
In the U.S., cancer remains a significant health problem. The American Cancer Society’s Cancer Facts and Figures 2016 shows, “Cancer is the second most common cause of death in the US, exceeded only by heart disease, and accounts for nearly 1 of every 4 deaths,” and “about 1,685,210 new cancer cases are expected to be diagnosed in 2016.”
Palliative Care: Whole Comfort, Education & Guidance
When people are living with cancer or another serious illness, it afflicts them and everyone who cares about them. Along with the physical effects of a disease can come a variety of other suffering, as patients and families endure many changes, confront difficult decisions, and feel fear, grief and other distress. Palliative care teams can be a great support, easing life for entire families.
Kevin Ache, DO, FAAHPM serves as the palliative care medical director at Empath Health. He cares for patients and families as well as oversees the palliative care consult services we provide throughout the community. In this Q&A, Dr. Ache discusses his dedication to this specialized medical field; our care teams’ work improving quality of life for patients and families; and the importance of advance care planning.
Q&A with Dr. Kevin Ache:
1. What’s your professional background?
I started at Suncoast Hospice | Empath Health five years ago after my hospice and palliative medicine fellowship at Mayo Clinic. Before that, I did my family medicine residency at The University of Tennessee Knoxville.
2. What are your credentials?
3. Why did you choose a career in palliative care?
When I was in residency I found that we spent so much time with patients at the beginning of life and tended to forget about them at the end of life. I realized our geriatric population is growing older and needs more assistance with pain and symptom management. I wanted to help them have a better quality of life.
4. What do you see as the most important responsibilities of palliative care physicians?
Definitely helping the families understand the disease process. Offering assistance early in the process is better. We educate families about their conditions and prognoses, and that in turn helps them make better decisions based on the knowledge that we offer them. We also help with pain and symptom management and advance care planning.
5. What qualities do you think palliative care physicians should possess?
We need to have compassion in order to convey the message. We may need to summarize all of the medical information in a way that the patients can understand it. Unfortunately, sometimes there are too many docs giving a lot of different information to patients and nobody giving them the overall picture.
6. Do you feel the community knows what palliative care is?
It’s a relatively new field in the spectrum of medicine. Physicians just started getting board certified in palliative care in 2008. There are many physicians as well as patients who don’t understand what palliative care is, and more education needs to be done in the community. I think the awareness is growing exponentially, and the reason is because people want to make their own choices in medicine rather than having it dictated to them. They want to pick what fits them best.
We’re at the cusp of palliative care starting to grow. It’s a really exciting time because it’s very much needed in the disease processes. Palliative care mostly is being done in hospitals although we’re seeing the need for palliative care to move out into the community, including nursing homes, assisted living and skilled nursing facilities, outpatient clinics and patients’ homes. Patients really can benefit.
7. Research shows lung, breast and colorectal cancers are the top three cancers worldwide. What cancers have your patients lived with?
Definitely our population within Pinellas County follows the national trends. At Empath Health, we work with a lot of cancer patients. Lung, breast, colorectal and prostate cancers are some of the main ones. We deal with a wide range of ages, including a majority of patients in the 60 to 80 age range, some in their 40s and even down to some younger ones in their 20s.
I think it’s important for us to get involved with them early in the disease process because studies have shown that patients can get through treatment better through pain and symptom management and they tend to have better outcomes. We work closely with our patients and their oncologists on goals of care.
8. Do you feel people understand cancer risks and are making lifestyle changes to prevent cancer?
I think our society has a greater awareness of all the health problems out there. In general, there’s less tobacco use and people are more in tune with their bodies and taking better care of themselves. Many do a lot of preventative medicine. It’s extremely important to stop a disease process before it starts or catch it earlier when there’s a better survival rate.
9. What types of challenges do cancer patients face?
One of the biggest challenges patients with cancer face is the unknown, wondering how they’re going to respond to treatment and what’s going to happen to them. There are a lot of new clinical and experimental treatments available and people respond differently to them. It’s exciting because there are more treatment options but it’s also more confusing given the litany of information out there. That’s where oncology comes in. And we can provide palliative care as an added layer of support to help patients understand and manage their symptoms.
10. How do palliative care teams comfort patients?
Palliative care is an interdisciplinary approach to patient care. The palliative care team is composed of a clinician, social worker and a chaplain because patients have different needs. This team approach works well in helping cover all their needs.
11. Many people choose integrative treatment as part of their care. What have you used with your patients?
In palliative medicine I see a need for massage therapy and Reiki. Acupuncture and osteopathic manipulative treatment are some things DOs can do. Music, pet and aroma therapies can also help. There are many alternatives so people aren’t just taking medications. I think all these can play a key factor in patients’ quality of life.
12. What have your experiences been like caring for patients of different cultures?
You have to be aware of different cultures in palliative care because they look at the disease process differently. It’s not the fact that the disease process is different with a lot of these patients, it’s more how they perceive it. It’s important how you present disease information.
13. What types of challenges do families and caregivers face and how do palliative care teams support them?
Families and caregivers go through a lot of the same problems as the patients, and even sometimes more difficult problems. There’s a lot of caregiver burnout and stress that’s put on these caregivers that they may not realize is there. The team approach provides support to caregivers and families, helping them understand as much as the patients do so they can make these decisions together.
14. How do you address advance care planning with patients and families?
It’s a tough subject to talk about. It’s also a necessary subject to talk about. Most patients haven’t had the discussion about advance care planning to the extent that it needs to be done. A lot of patients don’t understand the process of living wills, naming health care surrogates and when the documents take effect. I think there’s a huge role for us to play in educating on the importance of them. It’s good to delineate on paper how aggressive they want their treatment to be or not be so they can make sure their wishes are met.
15. What are the most valuable lessons you’ve learned in your work?
We see so many serious illnesses, not only in palliative care but all areas of medicine. It’s fulfilling to know we’re doing what our patients and families want and helping them live a better quality of life. I’ve learned life is precious and we need to cherish each day we have. I appreciate everything I have.
Have you recently been diagnosed with cancer or another serious illness? We can help you and your family with counseling. For more information, call us at 727-523-3451.
Caring for a friend or family member who’s seriously ill? Join our Caregiver Coffee Break meetings. For more information, visit our online calendar.