The World Health Organization (WHO) defines palliative care as an approach that improves the quality of life of patients – either adults or children – and their families, who are facing problems associated with a life-threatening illness.
Palliative care prevents and relieves suffering through early identification, correct assessment, as well as treatment of physical and psychosocial pain.
It focuses on enhancing the quality of life for patients with serious illnesses, especially those with advanced cancer.
In Malaysia, non-communicable diseases (NCDs) remain the leading cause of death.
While palliative care previously focused primarily on cancer-related patients, the Health Ministry introduced the National Palliative Care Policy and Strategic Plan (2019–2030) to provide a more cohesive approach for all diseases.
Since then, palliative care has significantly expanded its scope.
Nowadays, this form of care applies to all individuals suffering from progressive, life-threatening illnesses.
These include chronic organ failure, neurological disorders, persistent life-threatening infections, incurable hereditary diseases, and frail elderly individuals with multiple comorbidities (concurrent illnesses).
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Medicine is a fundamental component of effective palliative care.
When used correctly, medicines can significantly reduce pain and provide comfort in the final stages of life.
Given the rising incidence of cancer in Malaysia, it is crucial for both patients and healthcare professionals to understand the role of medicines in palliative care.
Common medicines
Rather than attempting to cure cancer, palliative care aims to improve the quality of life for patients, particularly those in the terminal stages.
The primary objective is to relieve symptoms such as pain, nausea, fatigue and loss of appetite.
Palliative care medications are tailored to each patient’s specific needs to achieve an acceptable level of comfort.
Commonly-used medicines in palliative care include:
Pain is one of the most common and distressing symptoms experienced by cancer patients.
The goal of palliative care is to manage this pain effectively.
Opioid analgesics are considered the most effective treatment for moderate to severe pain.
In Malaysia, commonly-used opioids for cancer patients include oxycodone, fentanyl and morphine.
While opioids provide significant relief, potential side effects such as drowsiness, constipation and the risk of dependence must be carefully managed.
When used as prescribed by a doctor, these medicines can effectively alleviate pain without causing dependency.
Additionally, non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and non-opioid analgesics like paracetamol, can also be used in treating mild to moderate pain.
Combining opioids with non-opioid medications can enhance pain management in cancer patients.
Nausea and vomiting are common side effects of cancer treatments, particularly chemotherapy.
These symptoms can significantly impact a patient’s quality of life and hinder their ability to maintain proper nutrition.
In some cases, cancer itself can induce nausea and vomiting, especially in advanced stages or when gastrointestinal blockages occur.
Doctors frequently prescribe anti-emetics, such as metoclopramide and ondansetron, to manage nausea and vomiting.
Corticosteroids, like dexamethasone, can also help prevent nausea and reduce inflammation.
Loss of appetite is common among cancer patients and can often lead to malnutrition and weight loss.
Examples of drugs used to stimulate appetite are megestrol acetate and dexamethasone.
Additionally, these medicines may help in reducing fatigue, another prevalent symptom in cancer patients.
The emotional burden of cancer, particularly in advanced stages, can lead to anxiety and depression.
To address these mental health concerns, doctors may prescribe benzodiazepines (such as lorazepam) and anti-depressants (such as sertraline or fluoxetine).
These medicines help patients feel more relaxed and better able to cope with their diagnosis.
For patients with bone metastases, medicines like denosumab and bisphosphonates (such as zoledronic acid) can help to manage bone pain and reduce the risk of complications like fractures.
These treatments strengthen bones, lower the likelihood of skeletal-related events, and improve mobility.
Advice for patients and families
Patients should be cautious about unregistered medicines that are widely advertised and marketed as quick solutions for cancer symptom management on social media.
These products often lack proper regulatory approval.
This means that their safety, effectiveness and quality cannot be guaranteed.
Taking unregistered medicines may lead to harmful side effects or interactions with prescribed treatments, ultimately worsening the patient’s condition.
Family members play a crucial role in supporting patients’ adherence to prescribed medicines, ensuring that treatments are taken correctly.
Strict adherence helps to control symptoms effectively, thus improving the patient’s quality of life.
If patients have any concerns about medicines taken or experience any side effects, they should discuss them with doctors or pharmacists.
Healthcare professionals can provide proper guidance on medicines use and managing side effects to ensure the best possible care.
A healthcare priority
With the rising number of cancer patients in Malaysia, expanding palliative care must be a healthcare priority.
This includes improving access to essential medicines, enhancing healthcare provider training, and increasing public awareness of symptom management.
While the Government has integrated palliative care into the public healthcare system, more efforts are needed to ensure equitable access for all patients, regardless of location or financial status.
The ultimate goal is to improve patients’ comfort and well-being in their final moments.
Palliative care is a compassionate approach that focuses on symptom management, pain relief and enhancing the quality of life for cancer patients.
Proper use of medicines plays a crucial role in achieving these goals.
Patients and their families should work closely with doctors and pharmacists to ensure medicines are used safely and effectively in palliative care.
For any inquiries regarding medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8am to 5pm, except on public holidays.
Prasyaanth Nadarajan is a pharmacist with the Pahang State Health Department. This article is courtesy of the Health Ministry’s Pharmacy Practice and Development Division. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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