Palliative Care of Young Adults: An Issue which Needs Higher and Better Awareness.

Young adults in the age group of 15–29 years are halfway between pediatric and adult oncology patients. This rightfully is considered as the no-man's land of cancer care. Development continues in physical, emotional, social, and cognitive spheres leading to the expectation of independence, whereas, at the same time, the diagnosis and treatment of malignancy causes progressive physical, intellectual, and emotional impairment leading to isolation and dependency.

Young patients are bothered by the spectrum of emotional and social concerns wider than any other age, major concerns being independence, education, career, employment, body image, sexuality, peer pressure, social acceptance, marriage, pregnancy, and parenthood. Conquering cancer in such patients requires the faith, talent, intellect, and resources of all members of the healthcare set-up. Palliative care in cancer patients is incomplete and inadequate without appropriate supports from the hospice, home care, and above all pain management teams.

Pain relief in palliative care cannot be considered in isolation and must be part of a multidisciplinary approach which encompasses physical, psychosocial, and spiritual aspects of pain and suffering. All of these elements of “total pain” must be considered in pain that is difficult to control. Satisfactory pain control is achievable in most palliative care patients. Pain is better controlled when patients, families and care providers understand that respiratory depression, addiction and the development of tolerance are not the problems with the optimal mix of opioids and early interventional cancer pain management. The patient, families, and care providers need to collaborate to achieve best results.

Palliative care in young is only incomplete without a discussion on their mental health issues. For young adults with cancer, the threat of death is real and present. Despair, depression, anger, guilt, and hopelessness takes an overtone, as the foundations of health, gathering strength, personal potential, and an open future on which adult identity is built are shattered. Loosing control over their future which is now determined by the external restrictions of an unwanted debilitating malignant disease leads to a feeling of impending doom. While they are unwell, their friends are exploring and enjoying life, finding new partners, enjoying their first romantic experiences, and moving ahead with their lives; this affects them further.

The professionals must facilitate opportunities for the young adult to be fully informed about their disease and prognosis, but must also be compassionate and sensitive enough at the same time, and trained enough to tackle the strong emotional outbursts (associated mostly with the initial and terminal course of palliative care) which might actually be a coping mechanism.

Adequate palliative care and pain management is said to be achieved when the spirit of fight unto death is inculcated in patients, which is reflected from their high moral, positive attitude, and strong self-belief. Creating decision space for young people is the real objective of palliative care. Young adults should be provided time to express their fears, concerns, and grief. Facilitating interaction with other young adults with cancer creates a comfortable space where they really become one of the crowds and are able to participate in discussions.

The real challenge of palliative care for a young adult is to recognize and support the needs of this growing individual with little experience of life as an adult, yet, at the same time facilitating his or her transition to an adulthood that may never be achieved.

Death is the destiny of every human on earth. For most patients with advanced cancer, the transition into the palliative phase is greatly assisted by palliative care services but requires the generosity of everyone who believes in the mysterious but strong alchemy of hard work and hope.

“The young…are full of passion, which excludes fear, and of hope, which inspires Confidence.”

(Aristotle, Rhetoric Book II).