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Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care

3898 - Integration of Oncology and Palliative Care

Date

22 Oct 2018

Session

Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care

Topics

End-of-life Care

Tumour Site

Presenters

Stein Kaasa

Citation

Annals of Oncology (2018) 29 (suppl_8): viii548-viii556. 10.1093/annonc/mdy295

Authors

S. Kaasa1, J.H. Loge1, T. Albreht2, E. Bruera3, A.T. Caraceni4, A. Cervantes5, I.J. Higginson6, K. Jordan7, P. Sjøgren8, P. Stone9, C. Zimmermann10, T. Lundeby1

Author affiliations

  • 1 Department Of Oncology, Oslo University Hospital, 424 - Oslo/NO
  • 2 Department Of Health Care, National Institute of Public Health of Slovenia, 1000 - Ljubljana/SI
  • 3 Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, 77030-4095 - Houston/US
  • 4 Palliative Care, Pain Therapy And Rehabilitation, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milan/IT
  • 5 Department Of Medical Oncology, University of Valencia, Valencia/ES
  • 6 Cicely Saunders Institute Of Palliative Care, Policy And Rehabilitation, King's College London, SE5 9PJ - London/GB
  • 7 Innere Medizin V - Hämatologie, Onkologie, Rheumatologie, University of Heidelberg, 69120 - Heidelberg/DE
  • 8 Department Of Oncology, University of Copenhagen, Copenhagen/DK
  • 9 Marie Curie Palliative Care Research Department, University College London, London/GB
  • 10 Department Of Supportive Care, Princess Margaret Cancer Center, M5G 2M9 - Toronto/CA
More

Resources

Abstract 3898

Background

Integration of oncology and palliative care (PC) combines two paradigms: the tumour-directed approach, which is the main focus of oncology, and the host-directed approach, which is the focus of PC. Contemporary PC aims to prevent, treat and reduce symptoms and suffering and to preserve and improve quality of life. A Lancet Oncology Commission was written on how PC and oncology can be integrated by combining these two approaches focusing content, models, organization of cancer care, public health, politics, education and research.

Methods

An international panel was established, consisting of experts in oncology, PC, public health and psycho-oncology. Literature searches were conducted, author meetings were held, and an interactive writing process was conducted.

Results

Integration is a complex process that involves various components of the health care system. The published RCTs on integration demonstrate health gains, but how and when to integrate is uncertain. Still, early delivery of specialist palliative care promotes patient-centeredness including shared-decision making, family involvement and regular use of patient-reported outcome measures. Barriers to integration include the perception of PC as end-of-life care, deficient planning at local, national and international levels, and insufficient infrastructure and funding. Furthermore, death and dying are stigmatized. The present competence in combined oncology and PC varies substantially and must be defined at all levels. The commission proposes to use standardized care pathways (SCPs) and multidisciplinary teams (MDTs) to promote integration. Integration raises new research questions: how much, when and how should PC be delivered and what is the minimum model for good care?

Conclusions

Integration involves the transition from a dualistic perspective - the tumor and the host- to a combined perspective. Integration must be recommended by health care authorities and decision-takers, followed by resource allocation and priority-setting. In all areas, the present volume of PC is too small to support integration on a broad scale. Implementation of integrated models is best secured by MDTs and SCPs. The combined perspective must be reflected in care models, education and research funding.

Clinical trial identification

Legal entity responsible for the study

Oslo University Hospital.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

S. Kaasa, J.H. Loge: Stockholder: Eir-solution. T. Albreht: Grants: European Commission and Ministry of Health of Slovenia, during the conduct of the study; Grants and personal fees: Pfizer Oncology, outside the submitted work. A.T. Caraceni: Grants: Molteni; Grants and personal fees: Italfarmaco; Personal fees: Sandoz, Pierre Fabre Institute; Gants: Gruenenthal, Ipsen, outside the submitted work. K. Jordan: Personal fees: MSD, Helsinn, Tesaro, Amgen, Pfizer, Merck, Hexal, outside the submitted work. All other authors have declared no conflicts of interest.

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