Oncology and Palliative Care

Question 1

What is the overall rate of cure for all cancers?

Answer 1

60%

Question 2

Describe the role of palliative care in oncology

Answer 2

• WHO report : should be integrated
• Framework for palliative care in Canada
• part of comprehensive cancer treatment
• early, integrated PC - improved QOL, survival
• incurable cancers only?

Question 3

How should patients be transitioned from oncology to PC?

Answer 3

• can be traumatic, abandonment
• best to do early alongside treatment
• state from beginning that goals will evolve from control of disease to symptom control
• Early as possible
• discuss in quiet, private place with key supportive people
• SPIKES
• Be honest, but not blunt
• use data
• commit to non abandonment
• Hope for the best, prepare for the worst
• don’t say “nothing more can be done”
• always offer palliation without chemo as option
• discuss impact of cancer tx on QOL

Question 4

How to maintain hope in incurable disease?

Answer 4

1. Emphasize what CAN be done.

• control of symptoms
• emotional support
• care and dignity
• practical support

2. Explore realistic goals
3. Discuss issues related to day to day living

Question 5

Describe 5 phases in natural history of cancer

Answer 5

1. Diagnosis
2. Curative primary therapy
3. Ambulatory palliative treatments
4. Inpatient palliative treatments (home care, hospice, LTC, hospital)
5. Secondary palliative therapy (EOL)

Question 6

SEQUENTIAL CARE : Model of Care

Answer 6

• Managed alone by oncology until disease modifying tx no longer an option
• transferred to palliative care
• sometimes PC involved earlier for pain management
• EOL care coordinated by PC
• requires close cooperation and communication
• timely referral

Advantages:

• clear definitions and responsbilities
• oncologist focuses on treatment

Question 7

ONCOLOGY-BASED PALLIATIVE CARE: Models of Care

Answer 7

• Oncologist provides cancer tx and pall care until death
• emphasizes oncologist / patient relationship
• continuity of care
• requires oncologist to have expertise/training in PC
• need PC specialist for backup for complex mx

Question 8

CONCURRENT MODEL: models of care

Answer 8

• oncologist and PC specialists collaborate
• Joint care
• Relative role depends on problems
• better patient outcomes, survival
• duality of advacned cancer care
• continuity of care

Question 9

Minimal requirements for Palliative Care in a Cancer Centre

Answer 9

• When receiving active therapy
• Inadequately controlled sx
• Provision of emergency care for sx control
• supportive and pall care for advanced, incurable cancer patients
• Social work, psychological care as routine
• Access to inpatient EOL care, hospice

Question 10

Optimal intergration of palliative care and oncology in cancer centre

Answer 10

• Close integration of pall care/oncology
• Philosophy of continuity and non abandonment
• high level home care with expert back up and coordination with primary care
• formal support for family members
• routine assessment for presence and severity of psychological and physical symptoms
• Expert medical and nursing care
• Expert care in the relief of psychological / existential distress
• Emergency care of symptoms
• Inpatient unit for symptom control
• reasearch/ QI
• Involvement in education

Question 11

Barriers to coordination between oncology and palliative care

Answer 11

• Different cultures of care
• Delays in referral to PC (EOL)
• Abandonment
• Territoriality