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H. Malhotra
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ED02 - Palliative Care in Lung Cancer: A Global Challenge (ID 264)
- Event: WCLC 2016
- Type: Education Session
- Track: Palliative Care/Ethics
- Presentations: 1
- Moderators:J. Crawford, J. Klastersky
- Coordinates: 12/05/2016, 11:00 - 12:30, Strauss 3
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ED02.03 - Palliative Care in India (ID 6429)
11:00 - 12:30 | Author(s): H. Malhotra
- Abstract
- Presentation
Abstract:
A cancer diagnosis is one of the most feared events rarely diagnosed before the late 20th century now competes with the Cardio-vascular disease, stroke, respiratory failure. The last half century has produced substantial advances in the treatment and early detection of few types of cancer and atleast modest gain in many other. Yet the reality is that half of the patients diagnosed with cancer will die within the first couple of years. With people living longer, the continued use of tobacco products, infectious disease that transmit cancer causing virus, and epidemic of obesity and arm-chair lifestyle, the cancer burden is projected to increase substantially over the decade. The delivery of high quality cancer care across the care continuum from diagnosis and treatment to maintaining the health of survivors and providing end-of-life care consistent with patients’ needs, values, and preferences. The provision of patient-centered care planning, palliative care, and psychosocial care; the prevention and management of long-term and late effects of cancer treatment; and family caregiver support should span the cancer care continuum from diagnosis through end-of-life care. The full cancer care continuum also includes the domains of prevention and risk reduction and screening. Cancer care for older adults, as noted throughout this report, is especially complex. Age is one of the strongest risk factors for cancer. The majority of cancer diagnoses and cancer deaths occur in individuals 65 years and older, and the majority of cancer survivors are in this age range. There are many important considerations to understanding the prognoses of older adults with cancer and formulating their care plans, such as altered physiology, functional and cognitive impairment, multiple coexisting morbidities, increased side effects of treatment, distinct goals of care, and the increased need for of social support. Their ability to participate in clinical trials has been limited, and thus the evidence base for informing treatment decisions in this population is lacking. The current health care delivery system is poorly prepared to address these concerns comprehensively. Thus, meeting the needs of the aging population will be an integral part of improving the quality of cancer care. Lung cancer is one of the commonest cancer causing death and it presents late. It is an extremely symptomatic disease and majority of the patients succumb to this disease. It is innately human to comfort and provide care to those suffering from cancer particularly who are close to death. Yet what seems evident as an individual’s personal level has by and large no guided policy all over the world. There is no argument that palliative care should be integrated into cancer care from diagnosis to death. Palliative care provides a specialized holistic approach to providing medical care with serious illness and the focus of Palliative Care is on providing relief from symptom and improving the quality of life of patients. Palliative Care is not End-of-Life or hospice but encompasses both. There is a dichotomy in the principle of medical care in cancer which single mindedly focuses on attempts to cure every patient at every stage. Recognition of the importance of symptom control and other aspects of Palliative care from diagnosis through dying process has been growing. Patients should not have to choose between treatment with curative intent or comfort care. There is need for both in varying degrees throughout the course of cancer whether the eventual outcome is survival or death. The goal is to maintain the best possible quality of life allowing the patients to choose whatever treatment they so wish while also meeting the needs of advanced disease through adequate symptom control. This goal is most often not met. For atleast half of those patients dying from cancer - most of whom are elderly and many vulnerable - death entails a spectrum of symptoms including pain, labored breathing, distress, nausea, confusion, and other physical and psychological conditions that go untreated and vastly diminishes the quality of remaining days. The patient is not the only one who suffers; family, care givers undergo unreleaved emotion and financial burden. This cannot be ignored within the context of the patients' who are terminally ill. A major problem in Palliative care is the under recognization, under diagnosis and thus undertreatment of the patients with significant stress ranging from existentional anguish, axiety and depression. Living with and eventually dying from a chronic illness runs substantial cost for patients, family, society and cost of those dying from cancer are 20% higher than average costs. Inadequacy of Palliative and End-of-Life care springs not from a single cause of a sector of society the separation of palliative and hospice care from potentially life prolonging treatment within the health care system, which is both influenced by and affects reimbursement policy; inadequate training of health care personnel in symptom management and other palliative care skills; inadequate standards of care and lack of accountability in caring for dying patients; disparities in care, even when available, for ethnic and socioeconomic segments of the population; lack of information resources for the public dealing with palliative and end-of-life care; lack of reliable data on the quality of life and the quality of care of patients dying from cancer (as well as other chronic diseases); and low level of public sector investment in palliative and end-of-life care research and training. This is not to suggest that there is no relevant ongoing research or relevant question or training program - there are - but the efforts are not coordinated and there is no focus for these activities in the Government agencies. What has resulted is under funding, lack of training and lack of research, leadership, with no sustained program for developing and disseminating Palliative treatment. Care for those approaching death is an integral and important part of health care. Everyone dies, and those at this stage of life deserve attention that is as thorough, active, and conscientious as that granted to those for whom cure or longer life is a realistic goal. Care for those approaching death should involve and respect both patients and those close to them. Particularly for patients with a grim prognosis, clinicians need to consider patients in the context of their families and close relationships and to be sensitive to their culture, values, resources, and other characteristics. Good care at the end of life depends on strong interpersonal skills, clinical knowledge, and technical proficiency , and it is informed by scientific evidence, values, and personal and professional experience. Clinical excellence is important because the frail condition of dying patients leaves little margin to rectify errors. Changing individual behavior is difficult, but changing an organization or a culture is potentially a greater challenge—and often is a precondition for individual change. Deficiencies in care often reflect flaws in how the health care system functions, which means that correcting problems will require change at the system level. The health care community has special responsibility for educating itself and others about the identification, management, and discussion of the last phase of fatal medical problems. Although health care professionals may not have a central presence in the lives of some people who are dying, many others draw heavily on physicians, nurses, social workers, and others for care—and caring. Thus, health care professionals are inescapably responsible for educating themselves and helping to educate the broader community about good care for dying patients and their families. More and better research is needed to increase our understanding of the clinical, cultural, organizational, and other practices or perspectives that can improve care for those approaching death. The knowledge base for good end-of-life care has enormous gaps and is neglected in the design and funding of biomedical, clinical, psychosocial, and health services research. Time is now to integrate Palliative care with mainstream care in cancer.
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