The multiplicity of existing models has the potential to act as a deterrant to the development of an economically feasible and self-sustaining model of delivery of supportive medicine services. A uniformity in guidelines governing the delivery of these services is urgently needed.
The department recently submitted an application for recognition as an ESMO Designated Centre for Integrated Oncology and Palliative Medicine. This paper tries to highlight the features unique to this model and builds upon the argument that the western model cannot be transplanted to the Indian setting.
The following salient features were identified. The department encourages cancer directed therapy where feasible and prides itself as being ahead of the times in proposing a model which incorporates various aspects of disease-directed therapy, supportive care and palliative care (including quality end of life care provision) as a continuum. A larger role for the palliative medicine professional with direct involvement in critical areas of supportive oncology, procedures such as therapeutic paracentesis, pigtail insertion and interventional pain management techniques is envisaged. We have been able to cut down significantly on the time spent for the patient in obtaining an expert liaison with specialists from other super-specialities. A weekly clinico-radiological conference is held where important cases are discussed with radiologists. The fact that advanced cancer patients (who are not recieving any cancer directed therapy) are being treated alongside those receiving active anticancer treatment has also been instrumental in creating an environment where there is no discrimination and stigma attached to the term palliation.
This model of delivery of supportive medicine services can act as a benchmark on which other regional centres can be modelled. The close involvement of professionals from disciplines such as anaesthesiology and radiology could be one of the important reasons in ensuring that this model has been successful in pushing the boundaries and managing patient issues which were traditionally considered outside the scope and ambit of palliative medicine.
Clinical trial identification
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Rahul D. Arora.
Has not received any funding
The author has declared no conflicts of interest.