These data illustrate that patients treated with adjuvant FAC chemotherapy plus radiotherapy have a slightly increased risk of leukemia. This information needs to be considered in the treatment plans for patients with breast cancer. However, for most patients, the benefits of adjuvant therapy exceed the risk of treatment-related leukemia.

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Patients with life threatening illness area characterized by multi-aspect of suffering. These various aspects of suffering area interrelated require a total comprehensive care by an interdisciplinary team. Palliative care means to address the total suffering of the patients and to maintain a rational hope when cure is absurd. Palliative care emphasizes the essential role of the family. Although the awareness about palliative care has been increasing, its development in Indonesia is still left behind compared to that of other Asian Countries. This paper discusses the definition of palliative care, total suffering, interdisciplinary approach, integration of palliative care in cancer management & barriers to Palliative Care.

Prognosis is one of the most critical factors affecting clinical decision in medical practice. In terminal illness where patients are only less than months to live, prognostication is essential to provide an appropriate plan, particularly to avoid futile treatment and to arrange palliative care referral. Prognostication is a process of foreseeing and foretelling, which enable the health care team, patients and family to be involved in the decision making. Determining prognosis is a challenge for doctors as lack of knowledge and skills and fear of the response of the patients and their families. Prognostication is essential in decision making among terminally ill patients, as the risks of adverse effects, energy, time and cost potentially outweighs the benefit of survival, quality of life, functional gain and hope. The benefit of prognostication is not only for the doctors, but particularly to the patients, their families, as well as to institution and health care system. In daily practice a subjective judgment made by doctor based on clinical assessment is usually overoptimistic. A tool is needed to make a better prognostication. Palliative Prognostic Index (PPI) and Palliative Prognostic Score (PaP score) are the most common tools used in palliative care setting.

Background: Rejection towards discharge planning of terminally ill patients and the role of family meetings to overcome such issue has not been evaluated. The aims of this study were to identify who and the reasons of rejection, to evaluate the effectiveness of family meetings, and to assess the important aspects in preparing homecare.Methods: This is an interventional study using queasy-experimental design. Samples of the study were family members of terminally ill patients who refused patient discharge from 1st of May to 31st of October 2016. Paired-Sample T-test was applied to analyze the result. Result: Rejections of discharge planning was mostly by the families. The most reason of rejection was lack of knowledge and skills in taking care of the terminally ill patients (40%). Family meetings solved the problem of rejection. The total score of 10 aspects needed in taking care of terminally ill patients was significantly increased (p=0.000). Conclusion: Family meetings effectively changed the attitude towards hospital discharged