BMJ  2005;330:963 (23 April), doi:10.1136/bmj.330.7497.963

Letter

Managing chronic diseases

Palliative care spectrum starts early on

The first 150 words of the full text of this article appear below.

EDITOR—Palliative care does not start when a patient is dying.¹ A whole spectrum of palliation begins from the day of diagnosis of a potentially terminal disease, such as soft tissue sarcoma.

Palliation, in the sense of needing to absorb what this means for the patient, becomes even then a medical imperative. The "How long have I got, Doc?" question may not be articulated, but it will be there and needs an empathetic response.

Curative treatment is sought, but—with sarcoma—lung metastases signal the end of that phase and the beginning of palliative treatment. The doctor and the patient know the dragon can be disabled but never slain. Palliation is then partnership, working to decide what may be gained at what cost. (This may apply during curative treatment: to take chemotherapy drugs now "just in case," or to keep them for later?)

Palliative treatment can be long (in sarcoma up . . . [Full text of this article]

Systems 4, Gidea Park, Essex RM2 6AH peter.cox@systems4.co.uk

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