Skip to main content
Erschienen in: Supportive Care in Cancer 3/2012

01.03.2012 | Original Article

Recommending early integration of palliative care — does it work?

verfasst von: Jan Gaertner, Juergen Wolf, Sebastian Frechen, Ursula Klein, Dennis Scheicht, Martin Hellmich, Karin Toepelt, Jan-Peter Glossmann, Christoph Ostgathe, Michael Hallek, Raymond Voltz

Erschienen in: Supportive Care in Cancer | Ausgabe 3/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

In 2006, our comprehensive cancer center decided to implement early integration (EI) of palliative care (PC) by (a) literally adopting the WHO definition of PC into cancer care guidelines and (b) providing a PC consulting team (PCST) to provide EI on in- and outpatient wards. The experience with this approach was assessed to identify shortcomings.

Methods

A retrospective systematic chart analysis of a 2-year period was performed.

Results

A total of 862 patients were treated (May 2006–April 2008). Many patients consulted by the PCST for the first time were already in a reduced performance status (ECOG 3 & 4: 40%) or experiencing burdening symptoms (i.e., dyspnoea 27%). After the first year (period A; “getting started”), the overall prevalence of symptoms identified on first PC contact decreased from seven to three, (p < 0.001) as well as surrogate measures for advanced disease (i.e., frailty: from 63% to 33%; CI: [−36%; −23%], p < 0.001).

Conclusion

Surrogate measures (symptom burden, performance status) indicate that PC was integrated earlier in the course of the disease after a 1-year phase of “getting started” with EI. Yet, the WHO recommendation alone was too vague to successfully trigger EI of PC. Therefore, the authors advocate the provision of disease specific guidelines to institutionalize EI of PC. Such guidelines have been developed for 19 different malignancies and are presented separately.
Literatur
1.
Zurück zum Zitat Ferris FD et al (2009) Palliative cancer care a decade later: accomplishments, the need, next steps—from the American Society of Clinical Oncology. J Clin Oncol 27(18):3052–3058PubMedCrossRef Ferris FD et al (2009) Palliative cancer care a decade later: accomplishments, the need, next steps—from the American Society of Clinical Oncology. J Clin Oncol 27(18):3052–3058PubMedCrossRef
2.
Zurück zum Zitat European Commission, promoting the development and integration of palliative care mobile support teams in the hospital—the fifth framework programme 1998–2002 “Quality of Life and mangement of living resources” 2003. European Commission, promoting the development and integration of palliative care mobile support teams in the hospital—the fifth framework programme 1998–2002 “Quality of Life and mangement of living resources” 2003.
3.
Zurück zum Zitat Gaertner J et al (2010) Implementing WHO recommendations for palliative care into routine lung cancer therapy: a feasibility study. J Palliat Med 13(6):727–732PubMedCrossRef Gaertner J et al (2010) Implementing WHO recommendations for palliative care into routine lung cancer therapy: a feasibility study. J Palliat Med 13(6):727–732PubMedCrossRef
4.
Zurück zum Zitat Gaertner J et al. (2011) Integrating palliative care into comprehensive breast cancer therapy—a pilot project. Breast Care (accepted) Gaertner J et al. (2011) Integrating palliative care into comprehensive breast cancer therapy—a pilot project. Breast Care (accepted)
5.
Zurück zum Zitat Levy MH et al (2009) NCCN clinical practice guidelines in oncology: palliative care. J Natl Compr Canc Netw 7(4):436–473PubMed Levy MH et al (2009) NCCN clinical practice guidelines in oncology: palliative care. J Natl Compr Canc Netw 7(4):436–473PubMed
6.
Zurück zum Zitat Zhukovsky DS et al (2009) The impact of palliative care consultation on symptom assessment, communication needs, and palliative interventions in pediatric patients with cancer. J Palliat Med 12(4):343–349PubMedCrossRef Zhukovsky DS et al (2009) The impact of palliative care consultation on symptom assessment, communication needs, and palliative interventions in pediatric patients with cancer. J Palliat Med 12(4):343–349PubMedCrossRef
7.
8.
Zurück zum Zitat Radbruch L et al (2004) What is the profile of palliative care in Germany. Results of a representative survey. Schmerz 18(3):179–188PubMedCrossRef Radbruch L et al (2004) What is the profile of palliative care in Germany. Results of a representative survey. Schmerz 18(3):179–188PubMedCrossRef
9.
Zurück zum Zitat Stiel S et al (2010) Validation of the new version of the minimal documentation system (MIDOS) for patients in palliative care: the German version of the Edmonton Symptom Assessment Scale (ESAS). Schmerz 24(6):596–604PubMedCrossRef Stiel S et al (2010) Validation of the new version of the minimal documentation system (MIDOS) for patients in palliative care: the German version of the Edmonton Symptom Assessment Scale (ESAS). Schmerz 24(6):596–604PubMedCrossRef
10.
Zurück zum Zitat Ostgathe C, et al. (2009) Differential palliative care issues in patients with primary and secondary brain tumours. Support Care Cancer. Ostgathe C, et al. (2009) Differential palliative care issues in patients with primary and secondary brain tumours. Support Care Cancer.
11.
Zurück zum Zitat Altman D, et al. (2000) Statistics with confidence. In: Altman D, Machin D, Bryant T, Gardner S (eds). BMJ Books, Wiley-Blackwell; 2nd Edition p. 50–54. ISBN-10: 0727913751, ISBN-13: 978-0727913753 Altman D, et al. (2000) Statistics with confidence. In: Altman D, Machin D, Bryant T, Gardner S (eds). BMJ Books, Wiley-Blackwell; 2nd Edition p. 50–54. ISBN-10: 0727913751, ISBN-13: 978-0727913753
12.
Zurück zum Zitat R Development Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. 2009: Vienna, Austria. R Development Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. 2009: Vienna, Austria.
13.
Zurück zum Zitat Twycross RG (2002) Palliative care: an international necessity. J Pain Palliat Care Pharmacother 16(1):61–79PubMedCrossRef Twycross RG (2002) Palliative care: an international necessity. J Pain Palliat Care Pharmacother 16(1):61–79PubMedCrossRef
14.
Zurück zum Zitat Yedidia MJ (2007) Transforming doctor-patient relationships to promote patient-centered care: lessons from palliative care. J Pain Symptom Manage 33(1):40–57PubMedCrossRef Yedidia MJ (2007) Transforming doctor-patient relationships to promote patient-centered care: lessons from palliative care. J Pain Symptom Manage 33(1):40–57PubMedCrossRef
15.
Zurück zum Zitat Temel JS et al (2010) Early palliative care for patients with metastatic non–small-cell lung cancer. N Engl J Med 363:733–742PubMedCrossRef Temel JS et al (2010) Early palliative care for patients with metastatic non–small-cell lung cancer. N Engl J Med 363:733–742PubMedCrossRef
16.
Zurück zum Zitat Grant M et al (2009) Current status of palliative care—clinical implementation, education, and research. CA Cancer J Clin 59(5):327–335PubMedCrossRef Grant M et al (2009) Current status of palliative care—clinical implementation, education, and research. CA Cancer J Clin 59(5):327–335PubMedCrossRef
17.
Zurück zum Zitat Cohen J et al (2008) Influence of physicians’ life stances on attitudes to end-of-life decisions and actual end-of-life decision-making in six countries. J Med Ethics 34(4):247–253PubMedCrossRef Cohen J et al (2008) Influence of physicians’ life stances on attitudes to end-of-life decisions and actual end-of-life decision-making in six countries. J Med Ethics 34(4):247–253PubMedCrossRef
18.
Zurück zum Zitat Periyakoil VS, Von Gunten CF (2007) Mainstreaming palliative care. J Palliat Med 10(1):40–42PubMedCrossRef Periyakoil VS, Von Gunten CF (2007) Mainstreaming palliative care. J Palliat Med 10(1):40–42PubMedCrossRef
19.
Zurück zum Zitat von Gunten CF (2008) Palliative medicine. Impact. J Palliat Med 11(4):536–537CrossRef von Gunten CF (2008) Palliative medicine. Impact. J Palliat Med 11(4):536–537CrossRef
20.
Zurück zum Zitat Schapira L et al (2009) Phase I versus palliative care: striking the right balance. J Clin Oncol 27(2):307–308PubMedCrossRef Schapira L et al (2009) Phase I versus palliative care: striking the right balance. J Clin Oncol 27(2):307–308PubMedCrossRef
21.
Zurück zum Zitat McNeil C (1999) Can guidelines be integrated into everyday practice? The NCCN in year 4. J Natl Cancer Inst 91(9):753–755PubMedCrossRef McNeil C (1999) Can guidelines be integrated into everyday practice? The NCCN in year 4. J Natl Cancer Inst 91(9):753–755PubMedCrossRef
22.
Zurück zum Zitat Bruera E, Hui D (2010) Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care. J Clin Oncol. Bruera E, Hui D (2010) Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care. J Clin Oncol.
23.
Zurück zum Zitat Bruera E, Hui D (2010) Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care. J Clin Oncol 28(25):4013–4017PubMedCrossRef Bruera E, Hui D (2010) Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care. J Clin Oncol 28(25):4013–4017PubMedCrossRef
24.
Zurück zum Zitat Morita T et al (2009) Late referrals to palliative care units in Japan: nationwide follow-up survey and effects of palliative care team involvement after the cancer control act. J Pain Symptom Manage 38(2):191–196PubMedCrossRef Morita T et al (2009) Late referrals to palliative care units in Japan: nationwide follow-up survey and effects of palliative care team involvement after the cancer control act. J Pain Symptom Manage 38(2):191–196PubMedCrossRef
25.
Zurück zum Zitat UnitedNations (2005) World Health Assembly: WHA 58.22 cancer prevention and control. UnitedNations (2005) World Health Assembly: WHA 58.22 cancer prevention and control.
26.
Zurück zum Zitat Snow CE et al (2009) Identifying factors affecting utilization of an inpatient palliative care service: a physician survey. J Palliat Med 12(3):231–237PubMedCrossRef Snow CE et al (2009) Identifying factors affecting utilization of an inpatient palliative care service: a physician survey. J Palliat Med 12(3):231–237PubMedCrossRef
27.
Zurück zum Zitat Von Roenn JH, von Gunten CF (2009) Are we putting the cart before the horse? Arch Intern Med 169(5):429CrossRef Von Roenn JH, von Gunten CF (2009) Are we putting the cart before the horse? Arch Intern Med 169(5):429CrossRef
28.
Zurück zum Zitat von Gunten CF (2009) Who uses palliative care? J Palliat Med 12(3):209CrossRef von Gunten CF (2009) Who uses palliative care? J Palliat Med 12(3):209CrossRef
Metadaten
Titel
Recommending early integration of palliative care — does it work?
verfasst von
Jan Gaertner
Juergen Wolf
Sebastian Frechen
Ursula Klein
Dennis Scheicht
Martin Hellmich
Karin Toepelt
Jan-Peter Glossmann
Christoph Ostgathe
Michael Hallek
Raymond Voltz
Publikationsdatum
01.03.2012
Verlag
Springer-Verlag
Erschienen in
Supportive Care in Cancer / Ausgabe 3/2012
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-011-1111-2

Weitere Artikel der Ausgabe 3/2012

Supportive Care in Cancer 3/2012 Zur Ausgabe

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.