SlideShare una empresa de Scribd logo
1 de 47
Descargar para leer sin conexión
PALLIATIVE & SUPPORTIVE
CARE IN ONCOLOGY
Infections
Diarrhoe/Obstipation
Cardiotoxicity
Neurotoxicity
Bone complications
Pulmonary Tox.
Renal toxicity
Antiemesis
Anaemia
Paravasation
Supportive measures in radiation therapy
Fertility
Fatigue Thrombocytopenia
Pain
Venous Thromboembolism
Tumorlysis
New Toxicities (Targeteddrugs)
Many aspects of supportive care
Nutrition
Lymphedema
Neutropenia
Psychological support
Supportive care improves patient reported outcomes in
cancer patients!
Definition of Supportive Care
Supportive care in cancer 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 treatment to post-treatment care
Supportive care aims to improve the quality of rehabilitation,
secondary cancer prevention, survivorship, and end-of-life care
MASCC = Multinational Association of Supportive Care in Cancer
Goals of Palliative Care
 To anticipate, prevent and reduce suffering
 To support the best possible quality of life to the patients, family &
care givers regardless of the stage of the disease or the need for other
therapies
Objectives
 To give the concept of palliative care in oncology
 To discuss the factors involved in palliative care
 To give the idea of approach to a patient of palliative care
 To discuss the Indian scenario of palliative care
 To give the concept of multidisciplinary approach
Definition
WHO:
Services designed to prevent & relieve suffering for patients and families facing
life-threatening illness through early management of pain & other physical,
psychosocial & spiritual problems
NCCN:
It is an approach to patient / family / care giver-centred health care that focus on
optimal management of pain and other distressing symptoms, while
incorporating psychosocial & spiritual care according to patient /family needs,
values, beliefs & cultures
Palliative care is Palliative care is not
Evidence based medical treatment It is not “giving up” on a patient
Vigorous care of pain and symptoms
throughout illness
Not in place of curative or life prolonging
care
Care that patients want at the same time
as efforts to cure or prolong life
Not the same as Hospice
ASCO : Recommendations
• The time to start palliative care is as soon as a patient cancer becomes advanced.
• For newly diagnosed patients with advanced cancer, the panel suggests that early
palliative care involvement within 8 wks after diagnosis
• In-patients and out-patients with advanced cancer should receive dedicated
palliative care services early in the disease course concurrent with active treatment
Palliative care should facilitate
a) Patient autonomy
b) Access to information
c) Choice
Palliative care becomes the main focus of care when disease- directed, life
prolonging therapies are no longer
a) Effective
b) Appropriate
c) Desired
Benefits of Early vs Traditional Palliative care
Who can practice Palliative Care?
Palliative care should be initiated by the primary oncology team & augmented by
collaboration with an inter disciplinary team of palliative care experts
When to a start Palliative Care?
Patients having one or more of the following
 Uncontrolled symptoms
 Moderate – severe distress related to cancer diagnosis and therapy
 Serious co-morbid physical and psychosocial conditions
 Complex psychosocial needs
 Poor prognosis
 Potentially life limiting disease
 Metastatic solid tumors
 Patient/ family/ care giver concerns about course of disease and decision
making
 Patient family care giver requests for palliative care
 Patient request for a hastened death
Indicators of short life expectancy
 Poor performance status [ ECOG >/= 3 ; KPS </= 50 ]
 Persistent hypercalcemia
 Brain/ CSF metastasis
 Delirium
 SVCO
 Spinal cord compression
 Cachexia
 Malignant effusions
 Palliative stenting /venting gastrostomy
Criteria for consultation with palliative care specialist
Patient characteristics
 Patient with life limiting cancer diagnosis
 Limited anticancer treatment options
 Need for clarifications of goals of care
 Resistance to engage in advance care planning
 High risk of poor pain management / resistant pain to conventional interventions
 High non-pain symptom burden, especially those resistant to conventional
management
 High distress
 Need for invasive procedures [i.e. palliative stenting/ venting gastrostomy]
 Frequent visits and hospital admissions
 Need for ICU level care
 Communication barriers [language /literacy /cognitive impairment]
 Request for hastened death
Assessment
The oncology team assesses the following
 Benefits /burdens of anti cancer therapy
 Patients / family /caregivers goals /values /expectations /priorities
 Symptom management
 Psychosocial distress
 Educational and informational needs / cultural factors affecting care
Role of palliative care in oncology
Benefits/ burdens of anti cancer therapy
 Natural history of specific tumor
 Potential for response to further treatment
 Potential for treatment related toxicities
 Patients understanding of disease prognosis
 Goals and meaning of anticancer therapy for patient, family, care givers
 Impairment of vital organs
 Performance status
 Serious co-morbid conditions
Patients/ family/ care-givers goals/ values/
expectations/ priorities
 Shared decision making with patients / family /care-givers
 Advance care planning
 Goals and meaning of anti cancer therapy
 Quality of life
Symptom management
 Pain
 Dyspnoea
 Anorexia / cachexia
 Nausea / vomiting
 Constipation
 Diarrhoea
 Malignant bowel obstruction
 Fatigue /weakness/ asthenia
 Insomnia / sedation
 Delirium
Psychosocial distress
 Psychological/psychiatric
- depression / anxiety
- distress
 Spiritual/ existential needs
 Social support challenges or concerns
- home
- family
- community
 Resource needs
Role of palliative care in oncology
Educational and informational needs or
cultural factors affecting care
 Patient/family/care-giver values and preferences about information &
communication
 Their perceptions of disease status
Hospice
 Definition : It is defined as the care that is designed to give supportive care to
people in the final phase of a terminal illness and focus on comfort and quality of
life, rather than cure.
 Goal : The goal is to enable patients to be comfortable and free of pain so that they
live each day as fully as possible.
 Hospice programmes : They are generally home based but they sometimes provide
services away from home [ i.e. In hospitals ].
 Philosophy : Is to provide support for the pts emotional, social & spiritual needs as
well as medical symptoms as a part of treating the whole person.
Bereavement
 It is the period of mourning after a loss / death.
 The team of palliative care also provides bereavement care
Hospice & palliative care development in India
 Palliative care has been developing in India since mid 1980s
 Now in India there are > 150 palliative and hospice centres in 16 states
 Mostly concentrated in large cities [but in Kerala it is more wide spread]
 Non governmental organizations, public and private hospitals
 But in rest of the states of India it is totally absent
Barriers to the development of palliative care are:
 Poverty
 Population density
 Opioid availability
 Work force development &
 Limited National palliative care policy
Developing palliative care in India
Based on the western models of palliative & hospice care for implementation in
Indian cultural context, successful models are being developed for
 Affordable
 Sustainable
 Community based palliative care services
Role of counselling in palliative care
 Most of the patients in palliative care suffer from depression therefore
counselling plays a very important role in palliative care
for the better cooperation of the patient and care takers
accepting the facts
to understand the treatment, its benefits and side effects
 The counsellor provides emotional & psychological support to patients
 Therefore it is a part of palliative care rather than considering it as separate
entity
Role of family physicians in palliative care
 Attending to palliative care needs is a responsibility of primary care doctors
 They are in a unique position to provide comprehensive care to the patient
 To make it possible for terminally ill patients to remain at home for the
remaining period of life , they should have an access to a doctor who is
Easily approachable
Skilled in palliative care
Prepared to come for a home visit
Provide round the clock care
 Therefore family physicians of palliative care patients should be trained for
the basic interventions and care to be offered
 Improving the skills of doctors in palliative care principles have to be
initiated in the profession so that they could meet the needs of challenging
society
Role of complimentary and alternative
medicine in palliative care
Alternative therapy
It is the term used to describe any medical treatment or intervention that has not
been sufficiently scientifically documented or identified as safe and effective for a
specific condition
All the following are alternative therapies :
 Acupuncture
 Guided imagery
 Chiropractic treatment
 Yoga & meditation
 Hypnosis
 Bio feedback therapy
 Aromatherapy
 Herbal remedies
 Massage
Integrative medicine
Integrative medicine : Medical care + Evidence based CAM
 Evidence based CAM should be added to medical care:
Patient dissatisfaction with conventional medical care alone
A need for personal control
Traditional and superstitious thoughts
Few benefits
 Some of the CAM have evidence in acting as adjuvants along with
medical treatment, therefore can be used
 Acupuncture and massage therapy may provide pain relief in cancer pain
/ in end stage patients
 Relaxation by imagery can improve oral mucositis pain
 Patients with severe COPD and dyspnoea may benefit from the use of
relaxation with breathing retraining
Metronomic chemotherapy
 To avoid the problems caused by traditional chemotherapeutic regimens a
new modality called Metronomic chemotherapy has been proposed
 It refers to the chronic equally spaced administration of low doses of
various chemotherapeutic drugs without extended rest periods
 The novelty of this modality lies not only in its anti tumor efficacy with
very low toxicity but also in a cell target switch, now aiming at tumor
endothelial cells
 This new concept includes the possibility of treating tumors that no longer
respond to traditional chemotherapy
Role of metronomic chemotherapy in palliative care
 Studies show that use of metronomic chemotherapy in palliative care in
various sites like
Head & neck ca
Breast ca
Ovarian ca
Advanced GI ca
Refractory haematological malignancies
 Showed cost effectiveness, well tolerated with minimal toxicity and
improved quality of life
Symptomatic management
Pain
• “Pain is whatever the experiencing person says it is, existing
whenever he/she says it does.”
- Margo McCaffery, 1968
• An unpleasant sensory and emotional experience associated
with actual or potential tissue damage, or described in terms of
such damage.
- International Association for the Study of Pain (IASP)
Pain
Adapted WHO pain ladder
End stage of life – peaceful death
Peaceful death is one that is free from avoidable distress and suffering of patients,
families and caregivers; in general accord with patients and family's wishes and
consistent with clinical cultural and ethical standards i.e.
 Freedom from pain
 Being at spiritual peace
 Being with family
Benefits of palliative care
Kavalieratos et al
Systematic review and meta analysis of 43 RCTs in palliative care vs usual care : both in
IP & OP settings
 Improved QOL & symptom burden
 No change in survival
 Improvements in advance care planning, patient and care-giver satisfaction and
lower health care utilization
Benefits of palliative care
Davis et al
A review of 62 studies on palliative care in ambulatory and home care [ 28 RCTs ]
 Improvements in depression, patient / cae-giver QOL,patient and family
satisfaction,care-giver burden
 Reduced aggressiveness at EOL, increased advanced directives
 Reduced hospital length of stay and hospitalizations,reduction in overall cost of
care
Benefits of palliative care
Temel et al
Patients with newly diagnosed stage IV NSCLC with standard monthly out patient
palliative care
 Improved QOL
 2.7 months medial benefit
 Less aggressive curative care [ 4th line chemo ]
 Hospice referral earlier and longer duration
 Improved prognostic awareness – less chemo at EOL
Take home message
• Palliative care is a part cancer therapy
• It should be started as early as possible
• The treating physician along with caregivers, patient and his family
should work as a team in palliative care
• Palliative care in India is still developing – therefore palliative care
policy and specific guidelines according to the Indian conditions should
be developed
Take home message
• All patients of cancer should be given good QOL till the end of life
• Hospice & bereavement should be a part of your palliation
• Counselling the patient and his family about the disease, options of
treatment and prognosis should be done for better decision making
Take home message
• Patient autonomy, willingness and preferences should be respected
• Emotional, spiritual & psychological support to be provided to the
patient and his family
• Finally the patient should have a pain free life till the last breath and a
peaceful death.
Thank you
“Supportive & Palliative Care
makes Excellent
Cancer Care possible”

Más contenido relacionado

La actualidad más candente

Hospice and palliative care
Hospice and palliative careHospice and palliative care
Hospice and palliative carestaciyac
 
Principles of surgical oncology
Principles of surgical oncologyPrinciples of surgical oncology
Principles of surgical oncologyChea Chan Hooi
 
Introduction to palliative care
Introduction to palliative careIntroduction to palliative care
Introduction to palliative careChai-Eng Tan
 
Cancer early screening and protection
Cancer early screening and protectionCancer early screening and protection
Cancer early screening and protectionMonkez M Yousif
 
Management of chemotherapy complications
Management of chemotherapy complicationsManagement of chemotherapy complications
Management of chemotherapy complicationssalaheldin abusin
 
Gastric cancer management
Gastric cancer managementGastric cancer management
Gastric cancer managementNabeel Yahiya
 
quality of life cancer
quality of life cancerquality of life cancer
quality of life cancerSanish
 
Palliative Care Across the Continuum
Palliative Care Across the ContinuumPalliative Care Across the Continuum
Palliative Care Across the ContinuumKindred Healthcare
 
Modalities of treatment for cancer
Modalities of treatment for cancerModalities of treatment for cancer
Modalities of treatment for cancerANILKUMAR BR
 
Advances in the management of breast cancer
Advances in the management of breast cancerAdvances in the management of breast cancer
Advances in the management of breast cancerMohamed Abdulla
 
Hospice and palliative care
Hospice and palliative careHospice and palliative care
Hospice and palliative careHADI HMOUD
 
Emergencies In Oncology
Emergencies In OncologyEmergencies In Oncology
Emergencies In OncologyDJ CrissCross
 

La actualidad más candente (20)

Palliative care concept
Palliative care concept Palliative care concept
Palliative care concept
 
Hospice and palliative care
Hospice and palliative careHospice and palliative care
Hospice and palliative care
 
Palliative care
Palliative carePalliative care
Palliative care
 
Principles of surgical oncology
Principles of surgical oncologyPrinciples of surgical oncology
Principles of surgical oncology
 
Introduction to palliative care
Introduction to palliative careIntroduction to palliative care
Introduction to palliative care
 
Cancer early screening and protection
Cancer early screening and protectionCancer early screening and protection
Cancer early screening and protection
 
Management of chemotherapy complications
Management of chemotherapy complicationsManagement of chemotherapy complications
Management of chemotherapy complications
 
Gastric cancer management
Gastric cancer managementGastric cancer management
Gastric cancer management
 
Radiotherapy
RadiotherapyRadiotherapy
Radiotherapy
 
quality of life cancer
quality of life cancerquality of life cancer
quality of life cancer
 
Palliative Care Across the Continuum
Palliative Care Across the ContinuumPalliative Care Across the Continuum
Palliative Care Across the Continuum
 
Oncological emergencies
Oncological emergenciesOncological emergencies
Oncological emergencies
 
Palliative Care
Palliative CarePalliative Care
Palliative Care
 
Modalities of treatment for cancer
Modalities of treatment for cancerModalities of treatment for cancer
Modalities of treatment for cancer
 
Principles of oncology
Principles of oncology   Principles of oncology
Principles of oncology
 
Advances in the management of breast cancer
Advances in the management of breast cancerAdvances in the management of breast cancer
Advances in the management of breast cancer
 
Carcinoma rectum (Rectal Cancer)
Carcinoma rectum (Rectal Cancer)Carcinoma rectum (Rectal Cancer)
Carcinoma rectum (Rectal Cancer)
 
Hospice and palliative care
Hospice and palliative careHospice and palliative care
Hospice and palliative care
 
Palliative vs Hospice Care
Palliative vs Hospice CarePalliative vs Hospice Care
Palliative vs Hospice Care
 
Emergencies In Oncology
Emergencies In OncologyEmergencies In Oncology
Emergencies In Oncology
 

Similar a Role of palliative care in oncology

The iahpc manual of palliative care 3e
The iahpc manual of palliative care 3eThe iahpc manual of palliative care 3e
The iahpc manual of palliative care 3epapahku123
 
The IAHPC manual of palliative care
The IAHPC manual of palliative careThe IAHPC manual of palliative care
The IAHPC manual of palliative careФонд Вера
 
PALLIATIVE CARE BY NIRBHAYKUMAR TRADA 531A.pptx
PALLIATIVE CARE  BY NIRBHAYKUMAR TRADA 531A.pptxPALLIATIVE CARE  BY NIRBHAYKUMAR TRADA 531A.pptx
PALLIATIVE CARE BY NIRBHAYKUMAR TRADA 531A.pptxssusercbc9e61
 
END OF LIFE CARE.docx
END OF LIFE CARE.docxEND OF LIFE CARE.docx
END OF LIFE CARE.docxPdianghun
 
45 minutes of suffering (or Anesthesia Grand Rounds on Palliative Care)
45 minutes of suffering (or Anesthesia Grand Rounds on Palliative Care)45 minutes of suffering (or Anesthesia Grand Rounds on Palliative Care)
45 minutes of suffering (or Anesthesia Grand Rounds on Palliative Care)Mike Aref
 
PALLIATIVE-AND-END-OF-LIFE-CARE.pptx
PALLIATIVE-AND-END-OF-LIFE-CARE.pptxPALLIATIVE-AND-END-OF-LIFE-CARE.pptx
PALLIATIVE-AND-END-OF-LIFE-CARE.pptxKimAmado
 
SHARE Presentation: Palliative Care for Women
SHARE Presentation: Palliative Care for WomenSHARE Presentation: Palliative Care for Women
SHARE Presentation: Palliative Care for Womenbkling
 
Ethical, moral and legal issues in oncology
Ethical, moral and legal issues in oncologyEthical, moral and legal issues in oncology
Ethical, moral and legal issues in oncologyManali Solanki
 
Primary and Specialty Palliative Care.pptx
Primary and Specialty Palliative Care.pptxPrimary and Specialty Palliative Care.pptx
Primary and Specialty Palliative Care.pptxMike Aref
 
Palliative care ppt gins.pptx
Palliative care ppt gins.pptxPalliative care ppt gins.pptx
Palliative care ppt gins.pptxRupa Verma
 
Living with Ovarian Cancer: How Palliative Care Can Help
Living with Ovarian Cancer: How Palliative Care Can HelpLiving with Ovarian Cancer: How Palliative Care Can Help
Living with Ovarian Cancer: How Palliative Care Can Helpbkling
 
Ppt on expanded role of nurse
Ppt on expanded role of nursePpt on expanded role of nurse
Ppt on expanded role of nurseNursing Path
 
Ppt on expanded role of nurse
Ppt on expanded role of nursePpt on expanded role of nurse
Ppt on expanded role of nurseNursing Path
 
Ppt on expanded role of nurse
Ppt on expanded role of nursePpt on expanded role of nurse
Ppt on expanded role of nurseNursing Path
 
Ppt on expanded role of nurse
Ppt on expanded role of nursePpt on expanded role of nurse
Ppt on expanded role of nurseNursing Path
 
Palliative Care And Pharmacist have to do
Palliative Care And Pharmacist have to doPalliative Care And Pharmacist have to do
Palliative Care And Pharmacist have to dosujatno angga
 

Similar a Role of palliative care in oncology (20)

Austin Pc Pre Conf
Austin Pc Pre ConfAustin Pc Pre Conf
Austin Pc Pre Conf
 
11715031.pdf
11715031.pdf11715031.pdf
11715031.pdf
 
Palliative care
Palliative carePalliative care
Palliative care
 
The iahpc manual of palliative care 3e
The iahpc manual of palliative care 3eThe iahpc manual of palliative care 3e
The iahpc manual of palliative care 3e
 
The IAHPC manual of palliative care
The IAHPC manual of palliative careThe IAHPC manual of palliative care
The IAHPC manual of palliative care
 
PALLIATIVE CARE BY NIRBHAYKUMAR TRADA 531A.pptx
PALLIATIVE CARE  BY NIRBHAYKUMAR TRADA 531A.pptxPALLIATIVE CARE  BY NIRBHAYKUMAR TRADA 531A.pptx
PALLIATIVE CARE BY NIRBHAYKUMAR TRADA 531A.pptx
 
END OF LIFE CARE.docx
END OF LIFE CARE.docxEND OF LIFE CARE.docx
END OF LIFE CARE.docx
 
45 minutes of suffering (or Anesthesia Grand Rounds on Palliative Care)
45 minutes of suffering (or Anesthesia Grand Rounds on Palliative Care)45 minutes of suffering (or Anesthesia Grand Rounds on Palliative Care)
45 minutes of suffering (or Anesthesia Grand Rounds on Palliative Care)
 
PALLIATIVE-AND-END-OF-LIFE-CARE.pptx
PALLIATIVE-AND-END-OF-LIFE-CARE.pptxPALLIATIVE-AND-END-OF-LIFE-CARE.pptx
PALLIATIVE-AND-END-OF-LIFE-CARE.pptx
 
SHARE Presentation: Palliative Care for Women
SHARE Presentation: Palliative Care for WomenSHARE Presentation: Palliative Care for Women
SHARE Presentation: Palliative Care for Women
 
Ethical, moral and legal issues in oncology
Ethical, moral and legal issues in oncologyEthical, moral and legal issues in oncology
Ethical, moral and legal issues in oncology
 
Primary and Specialty Palliative Care.pptx
Primary and Specialty Palliative Care.pptxPrimary and Specialty Palliative Care.pptx
Primary and Specialty Palliative Care.pptx
 
Palliative care ppt gins.pptx
Palliative care ppt gins.pptxPalliative care ppt gins.pptx
Palliative care ppt gins.pptx
 
CapeCodHospitalGrandRounds: Palliative Care
CapeCodHospitalGrandRounds: Palliative CareCapeCodHospitalGrandRounds: Palliative Care
CapeCodHospitalGrandRounds: Palliative Care
 
Living with Ovarian Cancer: How Palliative Care Can Help
Living with Ovarian Cancer: How Palliative Care Can HelpLiving with Ovarian Cancer: How Palliative Care Can Help
Living with Ovarian Cancer: How Palliative Care Can Help
 
Ppt on expanded role of nurse
Ppt on expanded role of nursePpt on expanded role of nurse
Ppt on expanded role of nurse
 
Ppt on expanded role of nurse
Ppt on expanded role of nursePpt on expanded role of nurse
Ppt on expanded role of nurse
 
Ppt on expanded role of nurse
Ppt on expanded role of nursePpt on expanded role of nurse
Ppt on expanded role of nurse
 
Ppt on expanded role of nurse
Ppt on expanded role of nursePpt on expanded role of nurse
Ppt on expanded role of nurse
 
Palliative Care And Pharmacist have to do
Palliative Care And Pharmacist have to doPalliative Care And Pharmacist have to do
Palliative Care And Pharmacist have to do
 

Más de DrAyush Garg

Overview of Carcinoma Prostate and Genetics
Overview of Carcinoma Prostate and GeneticsOverview of Carcinoma Prostate and Genetics
Overview of Carcinoma Prostate and GeneticsDrAyush Garg
 
Overview of brain tumors
Overview of brain tumorsOverview of brain tumors
Overview of brain tumorsDrAyush Garg
 
Hormonal therapy in breast cancer
Hormonal therapy in breast cancerHormonal therapy in breast cancer
Hormonal therapy in breast cancerDrAyush Garg
 
Breast cancer screening, prevention and genetic counselling
Breast cancer screening, prevention and genetic counsellingBreast cancer screening, prevention and genetic counselling
Breast cancer screening, prevention and genetic counsellingDrAyush Garg
 
Role of SBRT in lung cancer
Role of SBRT in lung cancerRole of SBRT in lung cancer
Role of SBRT in lung cancerDrAyush Garg
 
Role of hpv in head and neck tumors
Role of hpv in head and neck tumorsRole of hpv in head and neck tumors
Role of hpv in head and neck tumorsDrAyush Garg
 
Carcinoma esophagus
Carcinoma esophagusCarcinoma esophagus
Carcinoma esophagusDrAyush Garg
 
Cancer vaccines final
Cancer vaccines finalCancer vaccines final
Cancer vaccines finalDrAyush Garg
 
EXTRANODAL EXTENSION
EXTRANODAL EXTENSIONEXTRANODAL EXTENSION
EXTRANODAL EXTENSIONDrAyush Garg
 
Management of ca prostate
Management of ca prostateManagement of ca prostate
Management of ca prostateDrAyush Garg
 
Clinical Trials in Carcinoma Prostate
Clinical Trials in Carcinoma ProstateClinical Trials in Carcinoma Prostate
Clinical Trials in Carcinoma ProstateDrAyush Garg
 
Prognostic index in brain metastasis
Prognostic index in brain metastasisPrognostic index in brain metastasis
Prognostic index in brain metastasisDrAyush Garg
 
Supportive care and quality of life
Supportive care and quality of lifeSupportive care and quality of life
Supportive care and quality of lifeDrAyush Garg
 
Palliation brain, spinal and bone mets
Palliation brain, spinal and bone metsPalliation brain, spinal and bone mets
Palliation brain, spinal and bone metsDrAyush Garg
 
Small cell lung cancer
Small cell lung cancerSmall cell lung cancer
Small cell lung cancerDrAyush Garg
 

Más de DrAyush Garg (20)

Overview of Carcinoma Prostate and Genetics
Overview of Carcinoma Prostate and GeneticsOverview of Carcinoma Prostate and Genetics
Overview of Carcinoma Prostate and Genetics
 
OSTEOSARCOMA
OSTEOSARCOMAOSTEOSARCOMA
OSTEOSARCOMA
 
Overview of brain tumors
Overview of brain tumorsOverview of brain tumors
Overview of brain tumors
 
Hormonal therapy in breast cancer
Hormonal therapy in breast cancerHormonal therapy in breast cancer
Hormonal therapy in breast cancer
 
Multiple myeloma
Multiple myelomaMultiple myeloma
Multiple myeloma
 
Ear carcinoma
Ear carcinomaEar carcinoma
Ear carcinoma
 
Medulloblastoma
MedulloblastomaMedulloblastoma
Medulloblastoma
 
Breast cancer screening, prevention and genetic counselling
Breast cancer screening, prevention and genetic counsellingBreast cancer screening, prevention and genetic counselling
Breast cancer screening, prevention and genetic counselling
 
Role of SBRT in lung cancer
Role of SBRT in lung cancerRole of SBRT in lung cancer
Role of SBRT in lung cancer
 
Role of hpv in head and neck tumors
Role of hpv in head and neck tumorsRole of hpv in head and neck tumors
Role of hpv in head and neck tumors
 
Carcinoma esophagus
Carcinoma esophagusCarcinoma esophagus
Carcinoma esophagus
 
Cancer vaccines final
Cancer vaccines finalCancer vaccines final
Cancer vaccines final
 
EXTRANODAL EXTENSION
EXTRANODAL EXTENSIONEXTRANODAL EXTENSION
EXTRANODAL EXTENSION
 
Management of ca prostate
Management of ca prostateManagement of ca prostate
Management of ca prostate
 
Clinical Trials in Carcinoma Prostate
Clinical Trials in Carcinoma ProstateClinical Trials in Carcinoma Prostate
Clinical Trials in Carcinoma Prostate
 
Prognostic index in brain metastasis
Prognostic index in brain metastasisPrognostic index in brain metastasis
Prognostic index in brain metastasis
 
Supportive care and quality of life
Supportive care and quality of lifeSupportive care and quality of life
Supportive care and quality of life
 
Palliation brain, spinal and bone mets
Palliation brain, spinal and bone metsPalliation brain, spinal and bone mets
Palliation brain, spinal and bone mets
 
Retinoblastoma
RetinoblastomaRetinoblastoma
Retinoblastoma
 
Small cell lung cancer
Small cell lung cancerSmall cell lung cancer
Small cell lung cancer
 

Último

General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingAnonymous
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).kishan singh tomar
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...Ganesan Yogananthem
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxsumanchaulagain3
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
Pregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfPregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfMedicoseAcademics
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)Mohamed Rizk Khodair
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 

Último (20)

General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_Wellbeing
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptx
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
Pregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfPregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdf
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)
 
Cone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptxCone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptx
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 

Role of palliative care in oncology

  • 2. Infections Diarrhoe/Obstipation Cardiotoxicity Neurotoxicity Bone complications Pulmonary Tox. Renal toxicity Antiemesis Anaemia Paravasation Supportive measures in radiation therapy Fertility Fatigue Thrombocytopenia Pain Venous Thromboembolism Tumorlysis New Toxicities (Targeteddrugs) Many aspects of supportive care Nutrition Lymphedema Neutropenia Psychological support
  • 3. Supportive care improves patient reported outcomes in cancer patients!
  • 4. Definition of Supportive Care Supportive care in cancer 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 treatment to post-treatment care Supportive care aims to improve the quality of rehabilitation, secondary cancer prevention, survivorship, and end-of-life care MASCC = Multinational Association of Supportive Care in Cancer
  • 5. Goals of Palliative Care  To anticipate, prevent and reduce suffering  To support the best possible quality of life to the patients, family & care givers regardless of the stage of the disease or the need for other therapies
  • 6. Objectives  To give the concept of palliative care in oncology  To discuss the factors involved in palliative care  To give the idea of approach to a patient of palliative care  To discuss the Indian scenario of palliative care  To give the concept of multidisciplinary approach
  • 7. Definition WHO: Services designed to prevent & relieve suffering for patients and families facing life-threatening illness through early management of pain & other physical, psychosocial & spiritual problems NCCN: It is an approach to patient / family / care giver-centred health care that focus on optimal management of pain and other distressing symptoms, while incorporating psychosocial & spiritual care according to patient /family needs, values, beliefs & cultures
  • 8. Palliative care is Palliative care is not Evidence based medical treatment It is not “giving up” on a patient Vigorous care of pain and symptoms throughout illness Not in place of curative or life prolonging care Care that patients want at the same time as efforts to cure or prolong life Not the same as Hospice
  • 9. ASCO : Recommendations • The time to start palliative care is as soon as a patient cancer becomes advanced. • For newly diagnosed patients with advanced cancer, the panel suggests that early palliative care involvement within 8 wks after diagnosis • In-patients and out-patients with advanced cancer should receive dedicated palliative care services early in the disease course concurrent with active treatment
  • 10. Palliative care should facilitate a) Patient autonomy b) Access to information c) Choice Palliative care becomes the main focus of care when disease- directed, life prolonging therapies are no longer a) Effective b) Appropriate c) Desired
  • 11. Benefits of Early vs Traditional Palliative care
  • 12. Who can practice Palliative Care? Palliative care should be initiated by the primary oncology team & augmented by collaboration with an inter disciplinary team of palliative care experts
  • 13. When to a start Palliative Care? Patients having one or more of the following  Uncontrolled symptoms  Moderate – severe distress related to cancer diagnosis and therapy  Serious co-morbid physical and psychosocial conditions  Complex psychosocial needs  Poor prognosis  Potentially life limiting disease  Metastatic solid tumors  Patient/ family/ care giver concerns about course of disease and decision making  Patient family care giver requests for palliative care  Patient request for a hastened death
  • 14. Indicators of short life expectancy  Poor performance status [ ECOG >/= 3 ; KPS </= 50 ]  Persistent hypercalcemia  Brain/ CSF metastasis  Delirium  SVCO  Spinal cord compression  Cachexia  Malignant effusions  Palliative stenting /venting gastrostomy
  • 15. Criteria for consultation with palliative care specialist Patient characteristics  Patient with life limiting cancer diagnosis  Limited anticancer treatment options  Need for clarifications of goals of care  Resistance to engage in advance care planning  High risk of poor pain management / resistant pain to conventional interventions  High non-pain symptom burden, especially those resistant to conventional management  High distress  Need for invasive procedures [i.e. palliative stenting/ venting gastrostomy]  Frequent visits and hospital admissions  Need for ICU level care  Communication barriers [language /literacy /cognitive impairment]  Request for hastened death
  • 16. Assessment The oncology team assesses the following  Benefits /burdens of anti cancer therapy  Patients / family /caregivers goals /values /expectations /priorities  Symptom management  Psychosocial distress  Educational and informational needs / cultural factors affecting care
  • 18. Benefits/ burdens of anti cancer therapy  Natural history of specific tumor  Potential for response to further treatment  Potential for treatment related toxicities  Patients understanding of disease prognosis  Goals and meaning of anticancer therapy for patient, family, care givers  Impairment of vital organs  Performance status  Serious co-morbid conditions
  • 19. Patients/ family/ care-givers goals/ values/ expectations/ priorities  Shared decision making with patients / family /care-givers  Advance care planning  Goals and meaning of anti cancer therapy  Quality of life
  • 20. Symptom management  Pain  Dyspnoea  Anorexia / cachexia  Nausea / vomiting  Constipation  Diarrhoea  Malignant bowel obstruction  Fatigue /weakness/ asthenia  Insomnia / sedation  Delirium
  • 21. Psychosocial distress  Psychological/psychiatric - depression / anxiety - distress  Spiritual/ existential needs  Social support challenges or concerns - home - family - community  Resource needs
  • 23. Educational and informational needs or cultural factors affecting care  Patient/family/care-giver values and preferences about information & communication  Their perceptions of disease status
  • 24. Hospice  Definition : It is defined as the care that is designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life, rather than cure.  Goal : The goal is to enable patients to be comfortable and free of pain so that they live each day as fully as possible.  Hospice programmes : They are generally home based but they sometimes provide services away from home [ i.e. In hospitals ].  Philosophy : Is to provide support for the pts emotional, social & spiritual needs as well as medical symptoms as a part of treating the whole person.
  • 25. Bereavement  It is the period of mourning after a loss / death.  The team of palliative care also provides bereavement care
  • 26. Hospice & palliative care development in India  Palliative care has been developing in India since mid 1980s  Now in India there are > 150 palliative and hospice centres in 16 states  Mostly concentrated in large cities [but in Kerala it is more wide spread]  Non governmental organizations, public and private hospitals  But in rest of the states of India it is totally absent Barriers to the development of palliative care are:  Poverty  Population density  Opioid availability  Work force development &  Limited National palliative care policy
  • 27. Developing palliative care in India Based on the western models of palliative & hospice care for implementation in Indian cultural context, successful models are being developed for  Affordable  Sustainable  Community based palliative care services
  • 28. Role of counselling in palliative care  Most of the patients in palliative care suffer from depression therefore counselling plays a very important role in palliative care for the better cooperation of the patient and care takers accepting the facts to understand the treatment, its benefits and side effects  The counsellor provides emotional & psychological support to patients  Therefore it is a part of palliative care rather than considering it as separate entity
  • 29. Role of family physicians in palliative care  Attending to palliative care needs is a responsibility of primary care doctors  They are in a unique position to provide comprehensive care to the patient  To make it possible for terminally ill patients to remain at home for the remaining period of life , they should have an access to a doctor who is Easily approachable Skilled in palliative care Prepared to come for a home visit Provide round the clock care  Therefore family physicians of palliative care patients should be trained for the basic interventions and care to be offered  Improving the skills of doctors in palliative care principles have to be initiated in the profession so that they could meet the needs of challenging society
  • 30. Role of complimentary and alternative medicine in palliative care
  • 31. Alternative therapy It is the term used to describe any medical treatment or intervention that has not been sufficiently scientifically documented or identified as safe and effective for a specific condition All the following are alternative therapies :  Acupuncture  Guided imagery  Chiropractic treatment  Yoga & meditation  Hypnosis  Bio feedback therapy  Aromatherapy  Herbal remedies  Massage
  • 32. Integrative medicine Integrative medicine : Medical care + Evidence based CAM  Evidence based CAM should be added to medical care: Patient dissatisfaction with conventional medical care alone A need for personal control Traditional and superstitious thoughts
  • 33. Few benefits  Some of the CAM have evidence in acting as adjuvants along with medical treatment, therefore can be used  Acupuncture and massage therapy may provide pain relief in cancer pain / in end stage patients  Relaxation by imagery can improve oral mucositis pain  Patients with severe COPD and dyspnoea may benefit from the use of relaxation with breathing retraining
  • 34. Metronomic chemotherapy  To avoid the problems caused by traditional chemotherapeutic regimens a new modality called Metronomic chemotherapy has been proposed  It refers to the chronic equally spaced administration of low doses of various chemotherapeutic drugs without extended rest periods  The novelty of this modality lies not only in its anti tumor efficacy with very low toxicity but also in a cell target switch, now aiming at tumor endothelial cells  This new concept includes the possibility of treating tumors that no longer respond to traditional chemotherapy
  • 35. Role of metronomic chemotherapy in palliative care  Studies show that use of metronomic chemotherapy in palliative care in various sites like Head & neck ca Breast ca Ovarian ca Advanced GI ca Refractory haematological malignancies  Showed cost effectiveness, well tolerated with minimal toxicity and improved quality of life
  • 37. Pain • “Pain is whatever the experiencing person says it is, existing whenever he/she says it does.” - Margo McCaffery, 1968 • An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. - International Association for the Study of Pain (IASP)
  • 38. Pain
  • 40. End stage of life – peaceful death Peaceful death is one that is free from avoidable distress and suffering of patients, families and caregivers; in general accord with patients and family's wishes and consistent with clinical cultural and ethical standards i.e.  Freedom from pain  Being at spiritual peace  Being with family
  • 41. Benefits of palliative care Kavalieratos et al Systematic review and meta analysis of 43 RCTs in palliative care vs usual care : both in IP & OP settings  Improved QOL & symptom burden  No change in survival  Improvements in advance care planning, patient and care-giver satisfaction and lower health care utilization
  • 42. Benefits of palliative care Davis et al A review of 62 studies on palliative care in ambulatory and home care [ 28 RCTs ]  Improvements in depression, patient / cae-giver QOL,patient and family satisfaction,care-giver burden  Reduced aggressiveness at EOL, increased advanced directives  Reduced hospital length of stay and hospitalizations,reduction in overall cost of care
  • 43. Benefits of palliative care Temel et al Patients with newly diagnosed stage IV NSCLC with standard monthly out patient palliative care  Improved QOL  2.7 months medial benefit  Less aggressive curative care [ 4th line chemo ]  Hospice referral earlier and longer duration  Improved prognostic awareness – less chemo at EOL
  • 44. Take home message • Palliative care is a part cancer therapy • It should be started as early as possible • The treating physician along with caregivers, patient and his family should work as a team in palliative care • Palliative care in India is still developing – therefore palliative care policy and specific guidelines according to the Indian conditions should be developed
  • 45. Take home message • All patients of cancer should be given good QOL till the end of life • Hospice & bereavement should be a part of your palliation • Counselling the patient and his family about the disease, options of treatment and prognosis should be done for better decision making
  • 46. Take home message • Patient autonomy, willingness and preferences should be respected • Emotional, spiritual & psychological support to be provided to the patient and his family • Finally the patient should have a pain free life till the last breath and a peaceful death.
  • 47. Thank you “Supportive & Palliative Care makes Excellent Cancer Care possible”

Notas del editor

  1. Complementary and alternative based medicine