Principles of Palliative Care

According to the ASCO guideline, some essential components of palliative care are building a rapport and relationship with the patient and their caregivers; management of symptoms, distress, and functional status; educating patients and caregivers about their illness, prognosis, treatment goals, and expectations; supporting the patient and caregiver in their coping needs; coordinating with other care providers including referrals to other specialists as needed; and providing medical decision-making assistance to patients and caregivers.3 These services should begin within 8 weeks of a cancer diagnosis.

There are different strategies to helping providers engage in patient communication regarding palliative care, particularly for difficult topics such as end-of-life care or discussing testing results that indicate a poor prognosis.10 For example, the palliative service at Johns Hopkins University provides oncology providers with a temporary tattoo that can be placed on the forearm with several questions to help initiate difficult conversations, such as, “what is important to you?” “tell me about you as a person,” and, “what are you hoping for/what are your worries?”


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It is also important that patients and caregivers receive ongoing assessments of their benefits and burdens of cancer therapy, their symptoms, psychosocial needs, educational and informational needs, and their personal goals, values, and/or expectations.4 Patients should regularly undergo reassessment, as their needs are likely to change throughout their survivorship.

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Conclusions

Palliative care has evolved to provide interdisciplinary management of symptoms, psychosocial and spiritual needs, coping support, educational and informational needs, medical decision-making support, and discussions about treatment, prognosis, and personal goals. As a result, palliative care is an important aspect of oncology care and should be offered to all patients with advanced cancers early in their disease course.

References

  1. Miller KD, Siegel RL, Chieh C, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66:271-289. doi: 10.3322/caac.21349
  2. Denlinger CS, Sanft T, Baker KS, et al. Survivorship, Version 2.2018. NCCN Clinical Practice Guidelines in Oncology. September 24, 2018.
  3. Ferrell BR, Temel JS, Temin S, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline update. J Clin Oncol. 2017;35:96-112. doi: 10.1200/JCO.2016.70.1474
  4. Dans M, Smith T, Back A, et al. Palliative Care, Version 1.2018. NCCN Clinical Practice Guidelines in Oncology. December 19, 2017.
  5. Hui D, Hannon BL, Zimmermann C, Bruera E. Improving patient and caregiver outcomes in oncology: team-based, timely, and targeted palliative care. CA Cancer J Clin. 2018;68:356-376.
  6. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small cell lung cancer. N Engl J Med. 2010;363:733-742. doi: 10.1056/NEJMoa1000678
  7. Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. JAMA. 2009;302:741-749. doi: 10.1001/jama.2009.1198
  8. Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383:1721-1730. doi: 10.1016/S0140-6736(13)62416-2
  9. Ferrell B, Sun V, Hurria A, et al. Interdisciplinary palliative care for patients with lung cancer. J Pain Symptom Manage. 2015;50:758-767. doi: 10.1016/j.jpainsymman.2015.07.005
  10. Smith CB, Phillips T, Smith TJ. Using the new ASCO Clinical Practice Guideline for Palliative Care concurrent with oncology care using the TEAM approach. Am Soc Clin Oncol Educ Book. 2017;37:714-723. doi: 10.14694/EDBK_175474