Provision of Palliative Care and Pain Management Services for Oncology Patients

Abstract

Early initiation of palliative care to address pain and other symptoms offers the potential to improve quality of life for patients with cancer. The approaches to implementing and delivering palliative care and pain management services vary depending on patient needs, available resources, provider training, and clinical setting. This article describes the experiences in developing programs in which the need for early palliative care or pain management services for patients with cancer was recognized. In each case, collaborative efforts, careful planning, administrative support, and ample time were needed to implement such services. To tailor services based on the available resources, different approaches were taken, including structuring of services within oncology units; creation of an integrated partnership between oncology and palliative care departments; establishment of a multidisciplinary comprehensive service; and incorporation of nurse-based pain services to address acute, chronic, and cancer pain. These examples offer insights into how to optimize delivery of services in a variety of settings with varying resources. (JNCCN 2013;11(Suppl 1): S17-S27) recommends that combined standard oncology and palliative care should be considered early in the disease process for patients with metastatic cancer and/or a high symptom burden. Meanwhile, the European Society for Medical Oncology (ESMO) formalized the relationship between medical oncology and palliative care in a series of policy statements published in 2003. 4 These policies recognize that alleviation of pain and other symptoms should be given a high priority, that medical oncologists must be experts in evaluating and managing these symptoms, and that cancer centers should provide supportive and palliative care as part of their basic services. Provision of Palliative Care and Pain Management Services for Oncology PatientsAlthough agreement exists on the need for early palliative care services for patients with cancer, less guidance is available on optimal ways to develop successful programs. The availability of palliative care and pain management services varies by country and geographic location, and across medical centers. Programs incorporating palliative care services must base their design on the needs of the patients, the training and availability of health care providers, and the resources available.

Type and course of symptoms demonstrated in the terminal and dying phases by people with dementia in nursing homes

“…The ten symptoms identified for people suffering from dementia are similar to those described in the literature for cancers and chronic diseases such as chronic obstructive pulmonary disease (COPD) or for cardiovascular diseases [23,24,25,26,27,28,29,30]. Pain, breathing abnor-malities, feeding and drinking difficulties and mobility restrictions, including being bedridden, occur in the terminal phase of all illnesses.…”

NCCN Guidelines Insights: Palliative Care, Version 2.2017

“…Several groups have described their ideas and approaches for, experience and outcomes with, and barriers to developing successful programs that integrate palliative care into routine oncologic care. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] …”

MASCC/ESMO/EAPC survey of palliative programs

“…Palliative care as an element of cancer care requires a medical oncologist dedicated to palliative care [13]. The key to success is collaboration, commitment, continuity, communication, and patient centeredness.…”