Oncology/Palliative Care Assistant

Anonymous · November 2014

Saw this job posting today locally -- nothing extraordinary but it just hits me as a bit of a downer when they combine the words "Oncology & Palliative". Seriously, there is no cure for bc but there is no cure for lots of other diseases either. I may be nit-picking but I don't care it struck me the wrong way --

Oncology/Palliative Care Assistant:
JOB SUMMARY: Responsible to plan, organize and implement social work services for palliative care patients and families assuring that the medically related clinical, emotional, social and spiritual needs are met/maintained on an individual basis. Facilitates quality care/education for patients and their families; coordination, implementation and evaluation of clinical activities, patient, professional and public education, performance improvement and assists with administrative functions.

leggo · November 2014

I hear you. It bugs me too. To me it just denotes that it's inevitable. You can't win so we had to create this whole other area. I hate, hate it. There should have been a cure for this f'ng disease a long time ago. It's like everyone has just given up. Now we just hear about finding it early (bullshit), or the wonderfulness of palliative care. Not that they aren't wonderful, but seriously. It's so wrong.

dltnhm · November 2014

I'm sorry that this hit you the wrong way. When I see these words linked I do not automatically go to a terminal diagnosis. And am thankful that there are centers, hospitals, oncologists, etc that are upfront about the type of individual they are seeking for such an important position.

Here is one definition of palliative care:

What Is Palliative Care?

Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family.

Palliative care is provided by a team of doctors, nurses and other specialists who work together with a patient's other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.

leggo · November 2014

"at any stage in a serious illness and can be provided along with curative treatment".

Nope, not here. Only for pain-management and end-of-life decisions or only after all treatment has failed and your life expectancy is less than one year.....three weeks if you want in-patient care. As a matter of fact, where I live, you have to sign a DNR order to be in the program.

exbrnxgrl · November 2014

The definition that dltnhm provided is generally (though I'm sure not always) used in the US. Many people receive palliative care for illnesses other than cancer, but this particular job posting is specific to oncology. It is not the same as hospice and not necessarily end of life. DNR is not required, to the best of my knowledge. Yes, I wish with every fiber of my being that there was a cure, but am grateful,that palliative care exists when needed but the current reality is that many cancer patients will need palliative care. I don't think the job posting implies all or only cancer patients need this, palliation may be different at different stages and types of illnesses. You may need palliative care for a limited period of time or for extended periods of time. Again, very different from hospice.

Tomboy · November 2014

I have palliative people at the place I go. it is for psycho-social support, and also pain management. things like that. It is different than hospice, which my friend had to do, when there was nothing else they could do for her, and when the cancer in her brain would no longer let her comprehend why she was taking medicine. she had been aware and refused hospice until her and i both could not handle her anymore, she really needed to be helped made comfortable. And they were terrific. Hospice is when there is no hope of you living for longer than six months, and here where we were, you could no longer be on active treatment, but they did give her dexamethazone for swelling, and morphine for pain. She had to fill out a form with them, saying what she did or did not want, in terms of how she wanted to be supported. That day was one of her last lucid days, and i am so grateful for that. I had an earlier copy she had made years before, and updated regularly, so I know she meant it when she said no extraordinary effort should be taken to maintain her life. She did not want antibiotics, or to be tube-fed,or even any water. That no water bit was the one that bugged me, i thought you could't live for more than a week without it. She lasted 22 days. But apparently, years before, she had read it was an easier death and the hospice people said that was a right assumption. They really only want you to do what is right for you.

Anonymous · November 2014

Well maybe I missed the point, but to me, linking the two in the same phrase does give some an impression of "you have or [had] cancer and we're pretty sure you may have it again". My father was very ill with heart failure and a stroke a few years ago; the doctor gave him three months to live and they assigned a "palliative care" team to him. Where I live, palliative means preparing for end of life. Need I say more? Sure, he went on to prove the doctors wrong and lived about two more years, but nonetheless.

exbrnxgrl · November 2014

yes, the term palliative care is often misinterpreted. Not an uncommon thing with medical terms, diseases etc. It's great when we learn the accurate meaning of things! I could make a pretty long list about all the (common) misunderstandings I had about cancer in general and bc specifically I had, before I got cancer myself.

leggo · November 2014

Kathec, so sorry about your friend. I know it's a horrible thing to watch. I'm in Canada, so what we call palliative care is what the US might refer to as hospice (sometimes, not always as there are variations from province to province). I only think this because of what I've read on these boards about the US using a different terminology. Maybe that's not the case, though. Because of our health care system, palliative is free, hospice is something you pay for. Both are available for the same circumstances.

Either way, as I've worked in the field and was also a patient, I'm so grateful they're there, but hate that they have to be. That's why I can so relate to Shelly's post. Just the two terms together , in my neck of the woods, implies something.

Kathec, if you don't mind, please elaborate on the no water thing. Is it supposed to be easier because your kidneys will shut down? or what is the reasoning? It seems cruel, but if there's a reason and it's less painful, I'd like to know about it. Gawd knows I want to check out with the least amount of suffering and if that helps, I might want to add it to my orders.

Anonymous · November 2014

Kayb - yep I think the job posting appears to be reaching out to someone with definite cancer patient /end of life experience, at least that is how some (including me) may take it. Here is the Wikipedia definition of "palliative" care and I'm happy to see it is not always referred to in terminal diagnosis:

Palliative care^[1] is a holistic, multi-disciplinary approach that includes specialised medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family.^[2]^[3] Palliative care is provided by a team of doctors, nurses and other specialists who work together with a patient's other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.

Physicians sometimes use the term palliative care in a sense meaning palliative therapies without curative intent, when no cure can be expected (as often happens in late-stage cancers). For example, tumor debulking can continue to reduce pain from mass effect even when it is no longer curative. A clearer usage is palliative, noncurative therapy when that is what is meant, because palliative care can be used along with curative or aggressive therapies.

Starting in 2006 in the United States, palliative medicine is now a board certified sub-speciality of internal medicine with specializied fellowships for physicians who are interested in the field.^[4] Palliative care utilizes a multidisciplinary approach to patient care, relying on input frompharmacists, nurses, chaplains, social workers, psychologists and other allied health professionals in formulating a plan of care to relieve suffering in all areas of a patient's life. This multidisciplinary approach allows the palliative care team to address physical, emotional, spiritual and social concerns that arise with advanced illness.

Medications and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying diseaseor cause. This can include treating nausea related to chemotherapy or something as simple as morphine to treat the pain of broken leg or ibuprofen to treat aching related to an influenza (flu) infection.

Although the concept of palliative care is not new, most physicians have traditionally concentrated on trying to cure patients. Treatments for the alleviation of symptoms were viewed as hazardous and seen as inviting addiction and other unwanted side effects.^[5]

The focus on a person's quality of life has increased greatly since the 1990s. In the United States today, 55% of hospitals with more than 100 beds offer a palliative-care program,^[6] and nearly one-fifth of community hospitals have palliative-care programs.^[7] A relatively recent development is the palliative-care team, a dedicated health care team that is entirely geared toward palliative treatment.

dlb823 · November 2014

Many people assume pallative care means end of life care when that's not always the case. At UCLA I met with a pallative care doc simply due to a pain issue -- in my case to adjust pain meds I needed at the time but no longer even use, and I've never had to see her again. But I'm grateful to know there is someone there with specific expertise in pain management. So while pallative care docs are often involved in end of life tx, that's not the full scope of what many do. At least that's the way I interacted with one.

That job description sounds more like an assistant to what most hospitals would call an oncology social worker -- something that probably does involve end of life support services for some patients for whom pallative care might also be involved. But using the term pallative to describe or imply end of life only tx, is a very narrow definition.

I can see why the ad struck you the wrong way. It's not very well written and could appear to imply that "pallative" (in the end of life sense) & oncology are much more closely tied than they are for many survivors who don't require those sorts of services, including pain mgmt. Deanna

Oncology/Palliative Care Assistant

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