1a RIUNIONE NICSOROMA 12 MAGGIO 2014
Supportive cancer care – the fundamentals
SUPPORTIVE AND PALLIATIVE CARE
COMPLEMENTARY IN CANCER MANAGEMENT
MATTI S. AAPROGENOLIER, SWITZERLAND
1a RIUNIONE NICSOROMA 12 MAGGIO 2014
Supportive cancer care – the fundamentals
SUPPORTIVE AND PALLIATIVE CARE
COMPLEMENTARY IN CANCER MANAGEMENT
MATTI S. AAPROGENOLIER, SWITZERLAND
Distinction between
supportive care and palliative care
What are the objectives of supportive care?
What does supportive care mean to the clinician, nurse, patient, and caregivers?
Effective strategies to overcome the challenges and improve patient outcomes
Ethical considerations
Disclosures
• Collaborations in this field:• Teva, Sanofi, Sandoz, Roche,
Novartis, Merck, Johnson & Johnson, Hospira, Helsinn, Amgen
CLINIQUE DE GENOLIER
United Nations. Population Division. Department of Economic and Social Affairs. Population Ageing. 2050
Percentage of total population aged 60 years or older 2050
0–910–1920–24No data
Percentage aged60 years or older in 2050:
Distinction between
supportive care and palliative care
What are the objectives of supportive care?
What does supportive care mean to the clinician, nurse, patient, and caregivers?
Effective strategies to overcome the challenges and improve patient outcomes
Ethical considerations
SUPPORTIVE AND PALLIATIVE CARE
SUPPORTIVE AND PALLIATIVE CARE
• What is the difference between these two aspects of patient care?
• Where does "palliation" end or "support"
start?
SUPPORTIVE AND PALLIATIVE CARE
• One has to realize that there is a continuum in support and palliation.
• Today's management of patients with cancer is of a multidisciplinary nature, a fact exemplified by the bi-annual European Multidisciplinary Cancer Care Conference.
CANCER THERAPY
CURE PROLONG/PALLIATE
DEATH DIAGNOSIS RECURRENCE
PALLIATIVE CARE TEAM
MASCC Concept of Supportive Care
SUPPORTIVE CARE
D. Warr
SUPPORTIVE AND PALLIATIVE CARE
Historical reasons have led to the development of specialist groups with expertise towards issues
– frequent at the end of life (often called palliative care)
– around treatment management, and post-treatment issues (supportive care)
Distinction between
supportive care and palliative care
What are the objectives of supportive care?
What does supportive care mean to the clinician, nurse, patient, and caregivers?
Effective strategies to overcome the challenges and improve patient outcomes
Ethical considerations
SUPPORTIVE AND PALLIATIVE CAREMultinational Association for Supportive Care
in Cancer (MASCC) Supportive care is the prevention and
management of the adverse effects of cancer and its treatment. This includes management of physical and psychological symptoms and side effects across the continuum of the cancer experience from diagnosis through anticancer treatment to post-treatment care.
MASCC. www.mascc.org,
SUPPORTIVE AND PALLIATIVE CAREMultinational Association for Supportive Care
in Cancer (MASCC)
Enhancing rehabilitation, secondary cancer
prevention, survivorship and end of life care are integral to supportive care.
MASCC. www.mascc.org,
SUPPORTIVE AND PALLIATIVE CAREMultinational Association for Supportive Care
in Cancer (MASCC) Supportive care alleviates symptoms and
complications of cancer, reduces or prevents toxicities of treatment, supports communication with patients about their disease and prognosis, allows patients to tolerate and benefit from active therapy more easily, eases emotional burden of patients and caregivers, helps cancer survivors with psychological and social problems.
MASCC. www.mascc.org,
San Antonio Breast Cancer Symposium – December 10-14, 2013Cancer Therapy and Research Center at UT Health Science Center
This presentation is the intellectual property of the EBCTCG. Contact [email protected] for permission to reprint and/or distribute.
Effects Of Bisphosphonate Treatment On Recurrence And Cause-specific Mortality
In Women With Early Breast Cancer: A Meta-analysis Of Individual Patient Data
From Randomised Trials
R Coleman, M Gnant, A Paterson, T Powles, G von Minckwitz,
K Pritchard, J Bergh, J Bliss, J Gralow, S Anderson, D Cameron,
V Evans, H Pan, R Bradley, C Davies, R Gray.
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG)’s Bisphosphonate Working Group.
San Antonio Breast Cancer Symposium – December 10-14, 2013Cancer Therapy and Research Center at UT Health Science Center
This presentation is the intellectual property of the EBCTCG. Contact [email protected] for permission to reprint and/or distribute.
Mortality In Post-menopausal Women
Breast cancer mortality All cause mortality
1146 events 1524 events
Distinction between
supportive care and palliative care
What are the objectives of supportive care?
What does supportive care mean to the clinician, nurse, patient, and caregivers?
Effective strategies to overcome the challenges and improve patient outcomes
Ethical considerations
CINV ControlPROGRESS SINCE the 80’s
1978
Cisplatin (HEC)
Protocole “AC” CINV complete control Over 5 days
0% 10%
50% 50%
1988
60% 50%
1998
85% 75%
2008HD-MCP + Dex Setron + Dex Setron+ Dex + NK1RA
HD-MCP= Hi dose Metoclopramide haute doseDex = DexamethasoneCINV Chemo induced Nausea and Vomiting
Jordan K and Feyer P, 2012
SUPPORTIVE AND PALLIATIVE CARE There is recent interest in palliative care as a means
to support patients and have an impact on survival A study of patients with advanced non small-cell lung
cancer, has reported that early palliative care improves quality of life, mood, and survival despite less aggressive end-of-life care compared with standard oncology care alone
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.
Survie Globale
« Early Palliative Care »
Temel J et al. NEJM 2010
Standard Care Early Palliative Care
PALLIATIVE CAREAN ASCO POSITION
ASCO panel’s 2012 expert consensus indicates that combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden.
Smith TJ, Temin S, Alesi ER et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J ClinOncol. 2012; 30: 880-887.
SUPPORTIVE AND PALLIATIVE CAREESMO’s POSITION
ESMO had stated in 2003 already that “Since most cancer patients receive their cancer care in dedicated clinics or hospitals », it is imperative that these facilities provide an adequate supportive and palliative care infrastructure as part of the global service.
Cherny NI, Catane R, Kosmidis P. ESMO takes a stand on supportive and
palliative care. Ann Oncol 2003; 14: 1335-1337.
Distinction between
supportive care and palliative care
What are the objectives of supportive care?
What does supportive care mean to the clinician, nurse, patient, and caregivers?
Effective strategies to overcome the challenges and improve patient outcomes
Ethical considerations
SUPPORTIVE AND PALLIATIVE CAREThe European Society for Medical Oncology (ESMO)
ESMO has recognized the importance of patient centered care for a long time, and one of its key programmes is its Designated Centers of Integrated Oncology and Palliative Care.
ESMO. http://www.esmo.org/education-research/designated-centers-of-integrated-oncology-and-palliative-care.html
SUPPORTIVE AND PALLIATIVE CAREESMO Designated Centers
of Integrated Oncology and Palliative Care
Any oncology department or cancer center can apply: Size is not important; to be eligible what matters are the quality and the extent of the integration of services.
The criteria for accreditation are based on
recommendations from the World Health Organization (WHO) guidelines on the provision of palliative care for patients with cancer, and reflect the issues of integration, credentialing, service provision, research and education.
SUPPORTIVE AND PALLIATIVE CARE
None of the above comments detracts from the importance of centers of excellence in palliative care, named hospices in many cultures
Distinction between
supportive care and palliative care
What are the objectives of supportive care?
What does supportive care mean to the clinician, nurse, patient, and caregivers?
Effective strategies to overcome the challenges and improve patient outcomes
Ethical considerations
Take Home Message
“Supportive care makes excellent cancer care possible”
Dorothy M.K. Keefe, MASCC president
31
THE EUROPEAN SCHOOL OF ONCOLOGY
Alberto Costa,MD
Scientific Director
www.eso.net
CancerWorld Magazine2012
PREDICTING SURVIVAL[ECC 2013, Abs 1745].
Predictive Factors Points
Metastatic Sites ≥ 3 1
PS 1 1
LDH 250 - 600 U/l 1
Hb < 6,2 mmol/l 1
Albuminemia < 35 g/l 2
LDH > 600 U/l 2
PS ≥ 2 3
Rotteveel K et al. Abstract 1745 ESMO 2013.
FOUR GROUPS MEDIAN SURVIVAL (MS) AND MORTALITY (M)
AT 90 DAYS (D90)
• - Score ≥ 4: MS 2,6 ms D90 M 79%,• - Score = 3: MS 5,0 ms D90 M 43%,• - Score = 2: MS 7,1 ms D90 M 31%,• - Score = 1: MS 9,5 ms D90 M 28%,• - Score = 0: MS 15 ms D90 M 17%.
Rotteveel K et al. Abstract 1745 ESMO 2013.
and …..please access this article via theESO website
YES, A CONCLUSION IS NEEDED
SUPPORTIVE CARE IN CANCER
27th International Symposium
MASCC/ISOO
AVEC SÉANCE AFSOS
June 2014
MIAMI
U.S.A.
www.mascc.org
PARIS 15 – 17 Octobre 2014Espace Cardin
Paris
21-22-23 Novembre 2013HEGP Auditorium Paris
20 – 22 November 2014Georges Pompidou European
HospitalParis, France
43
AND ONE MORE USEFUL WEBSITE
http://qualityoflife.elsevierresource.com/
44
AND OF COURSE PLEASE COME TO THE
NEXT
NICSO MEETING!
NICSO 2014
CONCLUSION
SUPPORTIVE AND PALLIATIVE CAREARE
COMPLEMENTARY AND ESSENTIAL IN CANCER PATIENT TREATMENT
MATTI S. AAPROGENOLIER, SWITZERLAND