TMC PULSE

15 T M C » P U L S E | S E P T E M B E R 2 0 1 8 H istorically, medicine has focused on disease rather than whole-patient care. "In general, academic medicine has had great difficulty incorporating palliative care, support- ive care and—in a sense—whole-patient care into disease management," said Eduardo Bruera, M.D., medical director of the Supportive Care Center at The University of Texas MD Anderson Cancer Center and chair of the department of Palliative, Rehabilitation and Integrative Medicine. "But things are changing, and they're changing for the better." Bruera is a co-organizer of the Palliative Care and Spirituality for Life (PCSLife) conference, pre- sented by Houston Methodist Research Institute and the Roman Catholic Church's Pontifical Academy for Life in Vatican City. PCSLife will be held Sept. 17 at Houston Methodist Research Institute. Hosted in collaboration with MD Anderson's Department of Palliative, Rehabilitation and Integrative Medicine, PCSLife will feature pal- liative care and spiritual experts from Italy and across the United States. The conference will explore the importance of palliative care and spiri- tuality in clinical practice, the benefits of pallia- tive care to patients and health care systems, and best practices to help patients preserve dignity at the end of life. "There is no moment of greater distress than the moment in which we are going to end our lives," Bruera said. "It is never easy to be ill. It is always going to be difficult to die. We can never expect to turn the end of our lives into a pleasant experience, but there's a lot of unnecessary … physical, emotional, spiritual and family suffering. That is what we are very good at alleviating." Palliative care, a relatively new subspecialty in medicine, focuses on improving the quality of life for patients and their families. Its ethos is based on the understanding that treating patients doesn't mean just treating their disease; it means treating the patient as a whole and providing physical, psy- chosocial and spiritual support to alleviate pain and suffering. Palliative care is not just for the end of life, though that is often when it is needed. Palliative care pioneer Declan Walsh, M.D., chair of the department of supportive oncology at the Levine Cancer Institute in Charlotte, North Carolina, established the first palliative care program in the U.S. in 1987. He said that gaining a deeper understanding of what patients are experiencing through palliative care also plays an important role in clinical care. "Many of the challenges that cancer patients have around issues, like nutrition, are things that are important in palliative care, but they're also important because they teach us more about the nature of these illnesses," said Walsh, who will be speaking at PCSLife. "If we understand that better, we'll be able to provide better care for the patient, but also better understand how we can manage cancer as a disease." According to the World Health Organization (WHO), an estimated 40 million people require palliative care every year, but only about 14 per- cent of them receive it due to a lack of awareness and access. Cardiovascular diseases and cancer are the two main chronic ailments that require palliative care, along with other conditions includ- ing chronic respiratory diseases, AIDS, diabetes, multiple sclerosis and Parkinson's disease. In 2014, the World Health Assembly, the decision-making body of WHO, issued the first ever global resolution to encourage WHO and member states to improve and expand access to palliative care, calling it a "core component of health systems." In July, the U.S. House of Representatives approved H.R.1676, the Palliative Care and Hospice Education and Training Act. This bill amends the Public Health Service Act by requiring the Department of Health and Human Services to provide support for palliative care and hospice education centers. It also calls for the Agency for Healthcare Research and Quality to provide a national education and awareness cam- paign about the benefits of palliative care, and the National Institutes of Health to expand national research programs in palliative care. The bill is pending in the Senate. (continued) Palliative Care and Spirituality for Life Houston Methodist Research Institute to host a joint conference with the Pontifical Academy for Life on Sept. 17 B y S h a n l e y P i e r c e Palliative Care Palliative care improves the quality of life of patients and their families who are facing problems associated with life-threatening illness. This approach to care focuses on preventing and reliev- ing suffering through the early identification, correct assessment and treatment of pain and other problems—whether physical, psychosocial or spiritual. WHO NEEDS PALLIATIVE CARE EACH YEAR? Source: World Health Organization, 2014 Adults Age 60+ 69% Adults Age 15–59 25% Children Age 0–14 6% Source: World Health Organization Pa l l i at i v e C a r e

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