Cancer isn't the only malignant disease

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7344.1035 (Published 27 April 2002) Cite this as: BMJ 2002;324:1035

Palliative care can be useful in cardiovascular disease

  1. Richard H Sloan (medical@weld-hospice.org.uk), medical director
  1. Joseph Weld Hospice, Dorchester, Dorset DT1 2SL
  2. Brook House, Huntscott, Wootton Courtenay, Minehead TA24 8RR
  3. Accident and Emergency Department, Royal Lancaster Hospital, Lancaster, Lancashire LA1 4RP

    EDITOR—Moulder graphically illustrates the anguish of patients, professionals, and families when medical treatments have failed in end stage cardiovascular disease.1 In many respects, the same scenario existed with cancer until about 30 years ago. Doctors felt guilty that they didn't have anything else to offer. Patients and their families often sensed that they might be dying but suffered in silence. What changed to improve the lot for patients with cancer, and how could we learn from it?

    The modern palliative care movement, started in the late 1960s, highlighted the suffering of (mainly) patients with cancer and developed holistic strategies. Its success meant that it gradually became accepted as mainstream practice for patients in hospital or at home. No longer was cancer the taboo subject it was best not to talk about. Most patients eventually appreciated the opportunity to talk realistically about the likely course of their illness. Doctors realised that talk of specialist palliative care (hospice) services didn't necessarily frighten patients and often benefited them well before the final few days.

    Transferring this to end stage non-malignant disease has raised concerns. How do we know when the end stage has been reached? How do we detect the minority of patients who really would be frightened? Once the floodgates are opened to non-malignant disease how could hospice services possibly cope?

    I have worked in a hospice that has freely accepted patients with diseases other than cancer since opening eight years …

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