All ships are boats, but not all boats are ships—and so it is with palliative and hospice care.

Jupiter Medical Center board-certified hematologist and oncologist Jon S. Du Bois wants to get the word out: palliative care and hospice care are not interchangeable.

“They are separate entities,” says Du Bois, medical director of The Anderson Family Cancer Institute at JMC and program leader for gastrointestinal, neuroendocrine, and cutaneous cancers. “There’s confusion because there’s a similar skill set, and many programs offer both. The difference is with palliative care you’re typically trying to help a patient manage symptoms or complications related to cancer or some other condition.”

Other terms for palliative care are “supportive care” or “symptom management,” according to the American Cancer Society, which defines it as “a special approach to caring for anyone with a serious illness, including cancer.” It’s designed to complement treatment by providing relief from symptoms and stressors associated with the illness. Conversely, hospice care, will typically begin when active or curative treatment ends.

Palliative care can start as soon as someone is diagnosed with an acute or chronic illness. Research suggests that outcomes may be improved by getting an early start for the patient and their caregivers and loved ones.

Most patients undergoing treatment receive some components of palliative care from the physicians treating them for cancer, heart failure, neuromuscular disease, and certain lung diseases, such as chronic obstructive pulmonary disease. It might be in the form of helping to control nausea or ease breathing difficulties or provide physical therapy or pain management.

Integrating palliative specialists into the care team creates a holistic approach to the diverse needs of each person. “It’s a specialty unto itself,” Du Bois says. “Specialists are highly skilled and trained in the management of symptoms—pain management, breathing assistance, gastrointestinal issues, anxiety, and psychosocial issues. Any symptom or complication related to an illness is well managed by palliative care.”

When Du Bois was in medical school, palliative care was a fledgling field, but it continually developed as it became clear that patients with serious illnesses needed more than treatment for the disease alone. The American Board of Medical Specialties officially recognized hospice and palliative medicine as a subspecialty in the United States in 2006—19 years after it was officially recognized in the United Kingdom.

Palliative care physicians often advocate to support patients to ensure that their treatments are aligned with their goals and values. In addition to the medical knowledge necessary to control symptoms, manage the disease and pain, and recognize disease progression, palliative care specialists learn how to facilitate discussions with patients and their families about difficult diagnoses, disease management, advance care planning, and counseling resources. Specially trained palliative care team members can help patients who require the skills of a nurse practitioner, patient navigator, social worker, chaplain, dietician or nutritionist, or legal advisor.

In many ways, palliative care specialists are like an umbrella that covers a patient and their family, coordinating care with the surgeon, medical and radiation oncologists, overseeing quality of life, disease management, helping define the goals of care, and assist with advance care planning. It can also include transition to hospice care and bereavement assistance.

Now, through a new partnership, The Anderson Family Cancer Institute outpatients have convenient access to onsite Trustbridge palliative care and hospice services. “Many people think it’s just pain management, but it’s not. It will be woven into the fabric of the cancer center,” Du Bois explains. “Everyone will be under one roof—the surgeon, medical oncologist, radiation oncologist, nutritionist, physical therapist, social worker, and psychosocial support.”

The nonprofit Trustbridge provides support for families facing serious illness 24 hours a day with palliative medicine, hospice services, caregiver support, and bereavement programs.

Since 2022, The Anderson Family Cancer Institute inpatients could receive palliative care services through Trustbridge, but patients who weren’t hospitalized traveled to a separate location to access services. Now it is part of the cancer center’s outpatient services—in large part due to the generosity of donors. “Much of the time, in the health care environment, there’s a limited ability to fund new programs,” Du Bois says. “We are very fortunate to be funded by very generous donors.”

The Anderson Family Cancer Institute treats all types of cancer, with specialties in cancers of the breast, gastrointestinal, gynecologic, urologic, cutaneous systems, and lungs, as well as blood cancers such as leukemia, lymphoma, and myeloma. It offers a comprehensive range of treatments in one facility.

This collaborative and multidisciplinary approach is critical in managing cancer patients and families and sets The Anderson Family Cancer Institute apart from the various independent oncology clinics and offices in the area.

The addition of onsite palliative care teams is expected to lead to the same positive outcomes that researchers have found:

• Patients with chronic diseases, including cancer, have less severe symptoms if they receive palliative care. Their quality of life is improved, and they have less pain, shortness of breath, depression, and nausea.
• Cancer patients report improved emotional health if they receive palliative care.
• Studies suggest starting palliative care soon after diagnosis may extend survival, reports the American Cancer Society.

An American Medical Association Journal of Ethics article about high-quality palliative care states that it: “not only decreases costs but, more importantly, improves quality of life, patient satisfaction, caregiver burden, and survival in patients with serious illness.” Specifically for cancer care, it says that “palliative care improves several key metrics of quality by alleviating pain, depression, and psychosocial distress, fatigue, and dyspnea(breathing difficulties), and by providing information and care planning.”

While patients with a variety of illnesses benefit from palliative care, Du Bois believes it’s critical for those with cancer. “Particularly in advanced cancers, it can affect the whole body, so we make sure we partner with palliative specialists,” he says. “We’re not just treating symptoms; we’re treating the whole patient.”

Moving to JMC from Harvard-associated Mass General Hospital Cancer Center, Du Bois was excited to see that there were palliative care centers in the community “but there were none on the campus in the cancer center,” he says. “Now, we will be one of the first in the region— possibly the state—to have palliative care embedded within the cancer center.”

The palliative care program adds another discipline to those offered at The Anderson Family Cancer Institute. “To be a true comprehensive cancer center, you really need to be multidisciplinary,” Du Bois says. “This is yet another way to have a multidisciplinary team surrounding patients and families.”

Oncologists concentrate on treating the cancer, while palliative specialists may suggest alternate treatment modalities, such as a nerve block or acupuncture. “They are skilled at what medications, procedures, and other types of more holistic approaches may be appropriate,” Du Bois explains.

In addition to their knowledge in managing illness and treatment side effects, Du Bois says, palliative care specialists “are skilled at managing the human and emotional side of end-of-life scenarios. And they are very skilled at determining when it might be more appropriate for a patient to transition to hospice care.”

The palliative care expert helps fortify and deliver this mix of care in a coordinated manner. Having everything in one place makes it easier for patients to access and for the medical team to collaborate.

Du Bois sees great advantages to spending time with a patient focusing on their medical condition, then having the palliative care specialists follow up immediately thereafter. “They’re not replacing us, but bringing a higher-level skill set that may be required for many patients,” he says.

For instance, he recalls a young mother who had a hard-to-treat cancer. Merging her oncology care with palliative care “was critical in managing not just her cancer symptoms, which involved pain and breathing issues, but also the approach to her children, and managing family, psychological, and nutrition issues,” he says. “It helped fill the gap” between her medical treatment and her specific needs as a young mother.

Readily available palliative care services will add a vital component and, he hopes, help remove the stigma and misconceptions often attached to the term by those who don’t understand how it differs from hospice. “It’s a gift when you’re in the hospital or clinic to be able to see the oncologist and palliative care specialist who have been managing you,” Du Bois says. “We’re happy we finally have this coming online. It’s just so critical.”