Kuliah Dr Edi Hidayat

7/28/2019 Kuliah Dr Edi Hidayat

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Cancer and Palliative Care

It is generally estimated that roughly 7.2 to 7.5 million

people worldwide die from cancer each year.

More than 70% of all cancer deaths occur in developing

countries, where resources available for prevention,

diagnosis and treatment of cancer are limited or

nonexistent.

More than 40% of all cancers can be prevented. Others

can be detected early, treated and cured. Even with late-

stage cancer, the suffering of patients can be relievedwith good palliative care.


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Definitions: Palliative Care 2007

Active interdisciplinary care that aims to relieve sufferingand improve quality of life for patients with advanced

illness and their families.

It is offered simultaneously with all other appropriate

medical treatment.

WHO ( November 2007)


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The goal of Palliative Care

The goal is to improve the quality of life for individuals

who are suffering from severe diseases.

Palliative care offers a diverse array of assistance andcare to the patient.


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Definition of Terms

Supportive Care care that optimizes comfort, function and social

support of patient (and family) at all stages of illness

Palliative Care

care that optimizes comfort and function and socialsupport of patient (and family) when cure is not

possible

End of Life Care

palliative care when death is imminent


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Supportive Care

Palliative Care

EoL Care

Diagnosis Potentially

Curable

Non-Curable Terminal


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Palliative Care and Hospice

Hospice

-6 month expected

survival

Palliative Care-any time in disease process

-acutely-ill hospitalized pts

-chronic-debilitated

Ongoing disease-modifying treatment


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Palliative vs. Hospice Care

Palliative care can be provided from the time of

diagnosis.

Palliative care can be given simultaneously with curative

treatment.

Both services have foundations in the same philosophy

of reducing the severity of the symptoms of a sickness or

old age.

Other countries do not make such a distinction


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Who Provides Palliative Care?

Usually provided by a team of individuals

Interdisciplinary group of professionals

Team includes experts in multiple fields:

Doctors

Nurses

Social workers

massage therapists

Pharmacists Nutritionists


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Patientand

Family

Volunteers

Physicians

Spiritual

Counselors

Social Workers

Pharmacists

Home Health

Aides

Therapists

Nurses


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Approaches to Palliative Care

Not a one size fits all approach Care is tailored to help the specific needs of the

patient

Since palliative care is utilized to help with various

diseases, the care provided must fit the symptoms.

Image courtesy of uwhealth.org


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Supportive and Palliative Care training

for Medical Oncologists

Medical Oncologists must be skilled in the supportiveand palliative care of patients with advanced cancer.

9 core skills must be incorporated.

1. The oncologic management of advanced cancer

2. Communication with patients and family members3. The management of complications of cancer

4. Evaluation and management of physical symptoms of

cancer and cancer treatment

5. Evaluation and management of psychological and

existential symptoms of cancer6. Interdisciplinary care

7. Palliative care research

8. Ethical issues in the management of patients with cancer


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2. Communication with patients

and family members

Medical oncologist must be skilled in effective andcompassionate

Communication with cancer patients and their families.

Specific skills include:

1. Explaining diagnosis and treatment options

2. Disclosure of diagnosis

3. Explaining issues relating to prognosis

4. Explaining the potential risk and benefits of treatment options

5. Counseling skills to facilitate effective, informed decisionmaking.

6. Explaining the role of palliative care

7. The care of distressed family members: fear, anticipatorygrief, bereavement care

8. Convening of family meetings


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3. The management of complications

of cancer

Medical oncologists must be expert in the evaluation andmanagement of the complications of cancer including:

Bone metastases

CNS metastases

Neurological dysfunction: tumoral, paraneoplastic andiatrogenic

Liver metastases and biliary obstruction

Malignant effusions

Obstruction of hollow viscera

Metabolic consequences of cancer

Anorexia and cachexia

Hematologic consequences

Sexual d sfunction


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4. Evaluation and management of physical

symptoms of cancer and cancer treatment

Medical oncologists must be expert in the evaluationand management of the common physical symptoms of

advanced cancer including:

Pain

Dyspnea and cough Fatigue

Nausea and Vomiting

Constipation

Diarrhea

Insomnia

Itch


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5. Evaluation and management of

psychological and existential symptoms

of cancer

Medical oncologists must be familiarwith the evaluationand management of the common psychological andexistential symptoms of cancer including:

Anxiety Depression

Delirium

Suicidality and desire for death

Death anxiety

Anticipatory grief


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7. Palliative care research Medical oncologist must be familiarwith research

methodologies that are applicable to patients with cancerincluding:

Quality of life research

Pain measurement and research

Measurement of other physical and psychological

symptoms

Needs evaluation

Decision making research

Palliative Care audit


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9.Preventing Burnout

Medical oncologist must be familiar with the symptoms of

burnout, the factors that contribute to burnout and

strategies to prevent its development.


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Looking Forward


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Thank you !

Documents

Kuliah Dr Edi Hidayat