Cancer: palliative care denied to many patients

22/09/2014
Photo: Physician holding an old patient's hand

Many patients with advanced, incurable cancer do not receive any palliative care, reveals new research; ©Melpomene/ panthermedia.net

Many patients with advanced, incurable cancer do not receive any palliative care, reveals new research. The findings are astonishing as they come at the same time as 15 new oncology centres in Europe, Canada, South America and Africa are being awarded the prestigious title of 'ESMO Designated Centre of Integrated Oncology and Palliative Care.'

Dr Alexandru Grigorescu, medical oncology consultant at the Institute of Oncology Bucharest, Romania, member of the ESMO Palliative Care Working Group, said: "The integration of palliative care in oncology is a challenge. This is especially the case for countries with few resources, where the healthcare budget is low, with insufficient palliative care specialists and some drugs are unavailable as hospitals do not have the funds to buy them."

"ESMO brings a new approach to palliative care, namely by integrating it with specific anticancer treatment conducted in medical oncology departments," continued Grigorescu. "In this context, we conducted a study to assess palliative care needs and delivery in patients with advanced, incurable cancer."

The research was conducted in five Romanian and one Swiss institutes. It found that 17% of patients received no palliative care interventions and 26% did not have their symptoms addressed. One-fifth of patients wanted to discuss end-of-life issues with a healthcare professional, but it occurred in just 15% of cases. Only 10% of patients had a care plan.

Grigorescu said: "Our study shows that there are significant gaps in the delivery of palliative care for patients with advanced, incurable cancer. Our findings argue for healthcare decision-makers to increase the budget for palliative care. We hope the study will make a point about the importance of treating patients during this period. In Romania we do not have an independent speciality of palliative care, so it should be the responsibility of medical oncologists."

ESMO promotes good practice in palliative care for cancer patients through –among others-- the ESMO Designated Centers of Integrated Oncology and Palliative Care accreditation program. The designation recognizes that centers have achieved a high standard of integration of medical oncology and palliative care and is valid for three years.

Prof. Nathan Cherny, former chair of the ESMO Palliative Care Working Group and initiator of the Designated Centers program, said: "The ESMO Designated Centers program is the premier initiative worldwide for providing incentives and a structured model to enable centers to develop integrated programs in oncology and palliative care. The ESMO designation is widely recognized and indicates that the centre has made philosophical and infrastructural commitments to meet the physical and psychological challenges of patients and families with advanced cancers."

Cherny, an oncologist and palliative medicine specialist who is chair of humanistic medicine at Shaare Zedek Medical Centre, Jerusalem, Israel, added: "The designation also indicates that the centre is not only providing a clinical service but that it has programs developed both to push the boundaries of knowledge through research and to teach the essential skills required for the provision of palliative care to cancer patients."

Since the program began in 2003, the Designated Centre accolade has been awarded to 175 centers, of which 25 are in resource and/or regulation restrictive countries. In addition to the 15 new centers joining the prestigious group this year, 44 centers have achieved reaccreditation.

ESMO has been a leading player in identifying barriers to the availability and accessibility of essential pain relieving medication in Europe and in the developing world. Cherny said: "The findings from the Global Opioid Policy Initiative (GOPI) study have major policy implications that are relevant to over five billion of the world's population. We are working with our partners to promote legislative reforms to guarantee that all patients have access to affordable, effective pain medication to relieve the tragedy of needless suffering caused by undertreated cancer pain."

To promote better care for patients with advanced cancer ESMO published a guide for patients and their families and a companion volume for oncologists. The ESMO Guidelines Working Group is developing evidence-based clinical practice guidelines to assist oncologists in the provision of palliative care. This month three new guidelines have been published. Cherny said: "Together these publications help patients with advanced and incurable cancer ask appropriate questions and have meaningful discussions with their oncologist that lead to coordinated and holistic care. The patient book has been translated into 11 languages and is an invaluable resource."

MEDICA.de; Source: European Society for Medical Oncology ESMO