Palliative therapy

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As a palliative therapy or palliative therapy is defined as a medical treatment that is not aimed at the cure of a disease, but on the symptoms to reduce to alleviate or other adverse consequences ( palliation ) to improve the quality of life. According to established definitions of palliative medicine, palliative therapy does not have to be limited to the last phase of life, but can also be used, for example, together with causal tumor therapy in the early stages of the disease. Palliative therapy is in contrast to curative therapies , which aim at healing. The term palliative is derived from the Latin pallium “coat” and literally means “to encase”.

The measures of palliative medicine often have the goal of slowing down the progression of incurable diseases and reducing symptoms such as nausea, pain or (reactive) depression.

Forms of palliative therapy

Users of the palliative therapy of a patient have the right to treat the patient comprehensively and in particular to treat the problem areas from which the patient suffers most. These differ from patient to patient.

  • Pain therapy aims to alleviate acute and chronic pain conditions (provided that these are assigned an independent disease value, see also pain disorder ), but without treating the underlying ailment that causes the pain. Its primary goal is to improve the quality of life of the affected patients. Pain therapy is therefore curative with regard to the pain disorder and palliative with regard to the underlying ailment. Various painkillers are used for this. Depending on the situation, the medication can be administered as tablets, drops, lollipops , plasters, injections or as continuous infusions via syringes or PCA pumps .
  • Drug therapy: Drugs can often alleviate other problems for the patient. Examples: treatment of nausea, improvement of appetite, fight against constipation (e.g. due to painkillers or tumors), treatment of depression , treatment of intracranial pressure , reduction of shortness of breath .
  • psychotherapy
  • Improvement of the nutritional situation
  • The Palliative radiation aims to metastasis and growth reduction from malignant tumors, but it is clear from the outset that a cure of the tumor disease is unlikely. A classic example is the irradiation of bone metastases, which can cause severe pain and fractures due to pressure on the bone marrow.
  • Palliative chemotherapy cannot eliminate the (malignant) tumor disease, but it can influence the course of the disease and thus possibly extend the remaining life span of a patient. On the other hand, palliative chemotherapy in end-stage cancer patients may raise unjustified expectations and increase the likelihood of dying in hospital; partly under stressful circumstances.
  • A palliative operation is a surgical procedure, the aim of which is to alleviate the symptoms of a disease or to maintain vital body functions without the intention of a complete cure or elimination of the cause of the disease. For example, a piece of intestine can be removed in the event of an intestinal obstruction . As cytoreductive surgery or debulking refers to a maximum distance of tumor masses to facilitate palliative chemotherapy or palliative radiation treatment with the same goal. Accordingly, it is particularly suitable for tumors that generally respond well to chemotherapy or radiation.

Operations, radiation and chemotherapy are very (and often too) strenuous for the patient, which is why these measures must be carefully considered. The concept of palliative therapy also includes recognizing and stopping therapeutic measures that are unnecessary or that impair the quality of life ( Laurent Joubert already taught in the 16th century to forego the then common bloodletting or excessively drastic laxative measures in the case of terminally ill patients). Psychotherapeutic, possibly pastoral care is also part of palliative therapy concepts. The promotion of hope also plays a decisive role in the terminally ill and, as the doctor Ignatius Zach published as early as 1792, also contributes to improving the patient's physical condition.

See also

Individual evidence

  1. ^ Pschyrembel. De Gruyter, ISBN 3-11-007018-9 .
  2. ↑ Lukas Radbruch, Friedemann Nauck, Eberhard Aulbert: Basics of palliative medicine. Definition, development and goals. In: Eberhard Aulbert and others (ed.): Textbook of Palliative Medicine. Stuttgart 2012, pp. 1–32, here: p. 2.
  3. ↑ Further training regulations of the Bavarian State Medical Association from January 1, 2009, pdf
  4. ↑ Pain Therapy In: Roche Lexicon Medicine. 5th edition. Urban & Fischer, 2003.
  5. ↑ "What are the goals of radiation therapy?" Article on the website of the Clinic for Radiation Therapy and Radiation Oncology Lüneburg, accessed on November 21, 2019
  6. ↑ P. Leiner: When is palliative chemotherapy useful? Doctors newspaper, April 15, 2014, accessed March 7, 2017
  7. ^ A. Wright et al .: Associations between palliative chemotherapy and adult cancer patients' end of life care and place of death: prospective cohort study. March 4, 2014; BMJ 2014; 348: g1219 (English). Retrieved March 7, 2017
  8. ↑ Palliative surgery. In: Meyers Lexikon Online.
  9. ↑ Laurent Joubert: Oratio de praesidiis futuri excellentis medici. Geneva 1580, p. 15.
  10. ↑ Michael Stolberg : The history of palliative medicine. Medical care for the dying from 1500 until today. Mabuse-Verlag, Frankfurt am Main 2011, ISBN 978-3-940529-79-4 , p. 65.
  11. ↑ Ignatius Zach: De cura, quam moribundis debent, qui aegrotis sunt a ministerio. Frankfurt an der Oder 1792, p. 18.
  12. ↑ Michael Stolberg (2011), pp. 85-95.