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Marie Bakitas



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    ES22 - Quality of Life (ID 173)

    • Event: WCLC 2020
    • Type: Educational Session
    • Track: Palliative and Supportive Care
    • Presentations: 1
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      ES22.06 - Early Integration of Palliative Care Is the Answer to Improving Quality of Life (ID 3999)

      10:30 - 11:30  |  Presenting Author(s): Marie Bakitas

      • Abstract
      • Slides

      Abstract

      Multiple clinical trials and meta-analyses of palliative care integration into the care of patients with lung cancer and their family caregivers have demonstrated positive patient and family caregiver outcomes. Positive patient outcomes include quality of life, mood, symptom intensity, illness understanding, end-of-life care, and in some cases reduced resource utilization and survival (Hoerger, Wayser, Schwing, Suzuki, & Perry, 2018). Family/informal carers positive outcomes have included reduced burden and improved quality of life and mood(Alam, Hannon, & Zimmermann, 2020). Based on these results oncology organizations like the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recommend the palliative care referral close to the time of diagnosis for all patients with metastatic disease or high symptom burden (Kamal et al., 2020). Nevertheless, important issues remain unresolved. First, what is the best model of providing palliative care?(Hui & Bruera, 2020) Multiple clinicians and team configurations have produced positive results using in-person, telehealth and hybrid models. Second, when is the best time to offer palliative care? In clinical trials, integrated palliative care has been offered concurrent with oncology care within 60-90 days of diagnosis, yet in practice referral occurs quite close to the patients’ death in the form of hospice care (Kayastha & LeBlanc, 2020). Third, what is the ‘dose’ and ‘active ingredients’ of integrated palliative care? Various schedules and intensities of palliative care have shown positive outcomes, though at times results have depended on patients’ levels of physical and psychological function upon entering the study?(Hoerger, Greer, et al., 2018) Fourth, how can palliative care be provided in a way that is culturally-responsive to patients and families of different ethnicities, and with varying economic and health care resources? (Bakitas et al., 2020) And finally, given the positive results, why is palliative care not provided as a standard of care for all patients with advanced stage or symptomatic lung cancer? As we await results of clinical and implementation trials to answer these important questions, oncology providers, administrators, and policy makers need to determine how some level of clinical palliative care can be provided by existing oncology (primary palliative care) (Dionne-Odom et al., 2020) and palliative care specialist clinicians and teams (Hui & Bruera, 2020).

      References

      Alam, S., Hannon, B., & Zimmermann, C. (2020). Palliative Care for Family Caregivers. J Clin Oncol, 38(9), 926-936. doi:10.1200/jco.19.00018

      Bakitas, M., Allen Watts, K., Malone, E., Dionne-Odom, J. N., McCammon, S., Taylor, R., . . . Elk, R. (2020). Forging a New Frontier: Providing Palliative Care to People With Cancer in Rural and Remote Areas. J Clin Oncol, 38(9), 963-973. doi:10.1200/JCO.18.02432

      Dionne-Odom, J. N., Williams, G. R., Warren, P. P., Tims, S., Huang, C. S., Taylor, R. A., . . . Tucker, R. (2020). Implementing a Clinic-Based Telehealth Support Service (FamilyStrong) for Family Caregivers of Individuals with Grade IV Brain Tumors. J Palliat Med. doi:10.1089/jpm.2020.0178

      Hoerger, M., Greer, J. A., Jackson, V. A., Park, E. R., Pirl, W. F., El-Jawahri, A., . . . Temel, J. S. (2018). Defining the Elements of Early Palliative Care That Are Associated With Patient-Reported Outcomes and the Delivery of End-of-Life Care. Journal of Clinical Oncology, 36(11), 1096-1102. doi:10.1200/jco.2017.75.6676

      Hoerger, M., Wayser, G. R., Schwing, G., Suzuki, A., & Perry, L. M. (2018). Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials. Annals of Behavioral Medicine, 53(7), 674-685. doi:10.1093/abm/kay077

      Hui, D., & Bruera, E. (2020). Models of Palliative Care Delivery for Patients With Cancer. Journal of Clinical Oncology, 38(9), 852-865. doi:10.1200/jco.18.02123

      Kamal, A. H., Bausewein, C., Casarett, D. J., Currow, D. C., Dudgeon, D. J., & Higginson, I. J. (2020). Standards, Guidelines, and Quality Measures for Successful Specialty Palliative Care Integration Into Oncology: Current Approaches and Future Directions. Journal of Clinical Oncology, 38(9), 987-994. doi:10.1200/jco.18.02440

      Kayastha, N., & LeBlanc, T. W. (2020). When to Integrate Palliative Care in the Trajectory of Cancer Care. Curr Treat Options Oncol, 21(5), 41. doi:10.1007/s11864-020-00743-x

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