Integrating palliative care into oncology – improving the palliative care of cancer patients in the care pathway

Tiina Saarto, Board Member of the European Association for Palliative Care (EAPC), Professor of Palliative Medicine and Chief Physician of the Helsinki University Central Hospital, Cancer Center, Finland

Professor Tiina Saarto

Professor Tiina Saarto

As cancer incidence significantly increases across Europe there will be an increased need for palliative care for cancer patients in Finland. For example, the number of new cancer cases is expected to increase by 29 % by 2020. The increase occurs mainly in the elderly population as people live longer and have a higher risk of getting cancer. The other reason is improved cancer treatment and the prolonged survival of patients with non-curable cancer.

The needs of cancer patients are various; prevention and treatment of treatment-related toxicity, rehabilitation need, nutritional support, symptom control, psychosocial support and finally end of life care. Cancer is no longer the business of one specialty. Cancer care is based on multidisciplinary teamwork with medical oncologists, radiotherapists, surgeons, pathologists, radiologists, geriatrics and other specialists, not to mention the palliative care specialist. Palliative care should be in collaboration with oncology throughout the care pathway of cancer patients. As stated by the World Health Organization (WHO), palliative care should be introduced in oncology early in the course of illness in conjunction with anticancer therapies that are intended to prolong life, such as chemotherapy, biological therapies or radiotherapy, to better understand and manage distressing clinical complications and symptoms. Everything – from the symptom control of progressive disease and the adverse effects of treatments, psychosocial support, rehabilitation, nutritional support, bereavement counselling – to end of life care should be under the umbrella of palliative care. Palliative care will enhance the quality of life helping patients live as actively as possible until death and help the family cope during the patient’s illness and in their own bereavement. It may also positively influence the course of illness as demonstrated among patients with metastatic non–small-cell lung cancer; early palliative care led to significant improvements in quality of life and longer survival compared with standard care (Temel JS. N Engl J Med 2010;363:733-42).

How can we manage integration?
In the EAPC, we believe that we should collaborate with European oncology societies such as the European School of Medical Oncology (ESMO), an intention shared by ESMO. All comprehensive cancer centres have palliative and supportive care units. ESMO is accrediting Designated Centres of Integrated Oncology and Palliative Care and imposes specific requirements for the services offered. As palliative care professionals, we can contribute quality care, our broad knowledge and skills of symptom control, psychosocial care and existential support. Palliative care specialists should be responsible for advanced palliative care, but all oncologists should have basic skills. In my opinion, as a palliative care physician and an oncologist, and as a member of the EAPC and ESMO, this is our common goal. One example of this is the recent ECCO/ESMO congress in Amsterdam 2013; palliative and end of life care were included and the end of life care session was a success. Not all the participants could fit into the auditorium, which reflects the changed attitudes of young oncologists towards palliative and end of life care.

So what have we done in Finland, particularly in the Cancer Center of Helsinki University Hospital, to improve integration? In the palliative care unit, we have palliative care specialists with different background specialties, eg oncology, geriatrics and psychiatry. For young physicians specialising in oncology, three months’ training in the palliative care unit is mandatory, which has proved very helpful. In addition, seven out of 55 oncologists have special competence in palliative medicine and more are in training. This has improved the common understanding for palliative care needs of the patients throughout the illness and collaboration between oncologists and palliative care specialists within the Cancer Center and in primary care. Palliative care is highly respected among the oncologists. I think the time is right for collaboration.

Links and resources…

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3 Responses to Integrating palliative care into oncology – improving the palliative care of cancer patients in the care pathway

  1. Dear Professor Tiina Saarto,
    Your sentence ‘Palliative Care is highly respected among the oncologists. I think the time is right for collaboration’ is a great and wide O p e n i n g of meaning. And, within this Opening there is a high quality Action. EveryMan in Pain asks for this collaboration which is an Action for him and in him. Dear Professor, as a Linguist, since 2010 I have been studying Oncologic Pain in PreverbalChildren, in the field of Non-PharmacologicalCare: the Cognitive Distraction, the Imagery.
    The power of word, the power of image, before-and-for the power of pain. My studies will be present in India, for the first International Children’s Palliative Care Conference, in Mumbai, at the Tata Memorial Centre. The title of my Poster Presentation is ‘What-and-How does a PreverbalOncologicChild perceive, When he perceives? My Poster is in Memory of Giampaolo Magnani, my Little Nephew, born on 5th March 2009 and died on 17th October 2010.
    For EveryChild in the World I want to be-and-do my best. Luisella Magnani

  2. Pingback: Integrating palliative care into oncology – improving the palliative care of cancer patients in the care pathway | EAPC Blog | All Things Palliative - Article Feed

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