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
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…
- Kaasa S. Integration of general oncology and palliative care. The Lancet Oncology 2013;14 (7): 571-572 (accessed 27 January 2014).
- European School of Medical Oncology (ESMO).