1a RIUNIONE NICSO ROMA 12 MAGGIO 2014 Supportive cancer care – the fundamentals SUPPORTIVE AND...

1a RIUNIONE NICSOROMA 12 MAGGIO 2014

Supportive cancer care – the fundamentals

SUPPORTIVE AND PALLIATIVE CARE

COMPLEMENTARY IN CANCER MANAGEMENT

MATTI S. AAPROGENOLIER, SWITZERLAND

1a RIUNIONE NICSOROMA 12 MAGGIO 2014

Supportive cancer care – the fundamentals

SUPPORTIVE AND PALLIATIVE CARE

COMPLEMENTARY IN CANCER MANAGEMENT

MATTI S. AAPROGENOLIER, SWITZERLAND

Distinction between

supportive care and palliative care

What are the objectives of supportive care?

What does supportive care mean to the clinician, nurse, patient, and caregivers?

Effective strategies to overcome the challenges and improve patient outcomes

Ethical considerations

Disclosures

• Collaborations in this field:• Teva, Sanofi, Sandoz, Roche,

Novartis, Merck, Johnson & Johnson, Hospira, Helsinn, Amgen

CLINIQUE DE GENOLIER

United Nations. Population Division. Department of Economic and Social Affairs. Population Ageing. 2050

Percentage of total population aged 60 years or older 2050

0–910–1920–24No data

Percentage aged60 years or older in 2050:

Distinction between

supportive care and palliative care

What are the objectives of supportive care?

What does supportive care mean to the clinician, nurse, patient, and caregivers?

Effective strategies to overcome the challenges and improve patient outcomes

Ethical considerations

SUPPORTIVE AND PALLIATIVE CARE

SUPPORTIVE AND PALLIATIVE CARE

• What is the difference between these two aspects of patient care?

• Where does "palliation" end or "support"

start?

SUPPORTIVE AND PALLIATIVE CARE

• One has to realize that there is a continuum in support and palliation.

• Today's management of patients with cancer is of a multidisciplinary nature, a fact exemplified by the bi-annual European Multidisciplinary Cancer Care Conference.

CANCER THERAPY

CURE PROLONG/PALLIATE

DEATH DIAGNOSIS RECURRENCE

PALLIATIVE CARE TEAM

MASCC Concept of Supportive Care

SUPPORTIVE CARE

D. Warr

SUPPORTIVE AND PALLIATIVE CARE

Historical reasons have led to the development of specialist groups with expertise towards issues

– frequent at the end of life (often called palliative care)

– around treatment management, and post-treatment issues (supportive care)

Distinction between

supportive care and palliative care

What are the objectives of supportive care?

What does supportive care mean to the clinician, nurse, patient, and caregivers?

Effective strategies to overcome the challenges and improve patient outcomes

Ethical considerations

SUPPORTIVE AND PALLIATIVE CAREMultinational Association for Supportive Care

in Cancer (MASCC) Supportive care is the prevention and

management of the adverse effects of cancer and its treatment. This includes management of physical and psychological symptoms and side effects across the continuum of the cancer experience from diagnosis through anticancer treatment to post-treatment care.

MASCC. www.mascc.org,

SUPPORTIVE AND PALLIATIVE CAREMultinational Association for Supportive Care

in Cancer (MASCC)

Enhancing rehabilitation, secondary cancer

prevention, survivorship and end of life care are integral to supportive care.

MASCC. www.mascc.org,

SUPPORTIVE AND PALLIATIVE CAREMultinational Association for Supportive Care

in Cancer (MASCC) Supportive care alleviates symptoms and

complications of cancer, reduces or prevents toxicities of treatment, supports communication with patients about their disease and prognosis, allows patients to tolerate and benefit from active therapy more easily, eases emotional burden of patients and caregivers, helps cancer survivors with psychological and social problems.

MASCC. www.mascc.org,

San Antonio Breast Cancer Symposium – December 10-14, 2013Cancer Therapy and Research Center at UT Health Science Center

This presentation is the intellectual property of the EBCTCG. Contact r.e.coleman@sheffield.ac.uk for permission to reprint and/or distribute.

Effects Of Bisphosphonate Treatment On Recurrence And Cause-specific Mortality

In Women With Early Breast Cancer: A Meta-analysis Of Individual Patient Data

From Randomised Trials

R Coleman, M Gnant, A Paterson, T Powles, G von Minckwitz,

K Pritchard, J Bergh, J Bliss, J Gralow, S Anderson, D Cameron,

V Evans, H Pan, R Bradley, C Davies, R Gray.

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG)’s Bisphosphonate Working Group.

San Antonio Breast Cancer Symposium – December 10-14, 2013Cancer Therapy and Research Center at UT Health Science Center

This presentation is the intellectual property of the EBCTCG. Contact r.e.coleman@sheffield.ac.uk for permission to reprint and/or distribute.

Mortality In Post-menopausal Women

Breast cancer mortality All cause mortality

1146 events 1524 events

Distinction between

supportive care and palliative care

What are the objectives of supportive care?

What does supportive care mean to the clinician, nurse, patient, and caregivers?

Effective strategies to overcome the challenges and improve patient outcomes

Ethical considerations

CINV ControlPROGRESS SINCE the 80’s

1978

Cisplatin (HEC)

Protocole “AC” CINV complete control Over 5 days

0% 10%

50% 50%

1988

60% 50%

1998

85% 75%

2008HD-MCP + Dex Setron + Dex Setron+ Dex + NK1RA

HD-MCP= Hi dose Metoclopramide haute doseDex = DexamethasoneCINV Chemo induced Nausea and Vomiting

Jordan K and Feyer P, 2012

SUPPORTIVE AND PALLIATIVE CARE There is recent interest in palliative care as a means

to support patients and have an impact on survival A study of patients with advanced non small-cell lung

cancer, has reported that early palliative care improves quality of life, mood, and survival despite less aggressive end-of-life care compared with standard oncology care alone

Temel JS, Greer JA, Muzikansky A, et al: Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363:733-742.

Survie Globale

« Early Palliative Care »

Temel J et al. NEJM 2010

Standard Care Early Palliative Care

PALLIATIVE CAREAN ASCO POSITION

ASCO panel’s 2012 expert consensus indicates that combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden.

Smith TJ, Temin S, Alesi ER et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J ClinOncol. 2012; 30: 880-887.

SUPPORTIVE AND PALLIATIVE CAREESMO’s POSITION

ESMO had stated in 2003 already that “Since most cancer patients receive their cancer care in dedicated clinics or hospitals », it is imperative that these facilities provide an adequate supportive and palliative care infrastructure as part of the global service.

Cherny NI, Catane R, Kosmidis P. ESMO takes a stand on supportive and

palliative care. Ann Oncol 2003; 14: 1335-1337.

Distinction between

supportive care and palliative care

What are the objectives of supportive care?

What does supportive care mean to the clinician, nurse, patient, and caregivers?

Effective strategies to overcome the challenges and improve patient outcomes

Ethical considerations

SUPPORTIVE AND PALLIATIVE CAREThe European Society for Medical Oncology (ESMO)

ESMO has recognized the importance of patient centered care for a long time, and one of its key programmes is its Designated Centers of Integrated Oncology and Palliative Care.

ESMO. http://www.esmo.org/education-research/designated-centers-of-integrated-oncology-and-palliative-care.html

SUPPORTIVE AND PALLIATIVE CAREESMO Designated Centers

of Integrated Oncology and Palliative Care

Any oncology department or cancer center can apply: Size is not important; to be eligible what matters are the quality and the extent of the integration of services.

The criteria for accreditation are based on

recommendations from the World Health Organization (WHO) guidelines on the provision of palliative care for patients with cancer, and reflect the issues of integration, credentialing, service provision, research and education.

SUPPORTIVE AND PALLIATIVE CARE

None of the above comments detracts from the importance of centers of excellence in palliative care, named hospices in many cultures

Distinction between

supportive care and palliative care

What are the objectives of supportive care?

What does supportive care mean to the clinician, nurse, patient, and caregivers?

Effective strategies to overcome the challenges and improve patient outcomes

Ethical considerations

Take Home Message

“Supportive care makes excellent cancer care possible”

Dorothy M.K. Keefe, MASCC president

31

THE EUROPEAN SCHOOL OF ONCOLOGY

Alberto Costa,MD

Scientific Director

www.eso.net

CancerWorld Magazine2012

PREDICTING SURVIVAL[ECC 2013, Abs 1745].

Predictive Factors Points

Metastatic Sites ≥ 3 1

PS 1 1

LDH 250 - 600 U/l 1

Hb < 6,2 mmol/l 1

Albuminemia < 35 g/l 2

LDH > 600 U/l 2

PS ≥ 2 3

Rotteveel K et al. Abstract 1745 ESMO 2013.

FOUR GROUPS MEDIAN SURVIVAL (MS) AND MORTALITY (M)

AT 90 DAYS (D90)

• - Score ≥ 4: MS 2,6 ms D90 M 79%,• - Score = 3: MS 5,0 ms D90 M 43%,• - Score = 2: MS 7,1 ms D90 M 31%,• - Score = 1: MS 9,5 ms D90 M 28%,• - Score = 0: MS 15 ms D90 M 17%.

Rotteveel K et al. Abstract 1745 ESMO 2013.

and …..please access this article via theESO website

YES, A CONCLUSION IS NEEDED

SUPPORTIVE CARE IN CANCER

27th International Symposium

MASCC/ISOO

AVEC SÉANCE AFSOS

June 2014

MIAMI

U.S.A.

www.mascc.org

PARIS 15 – 17 Octobre 2014Espace Cardin

Paris

21-22-23 Novembre 2013HEGP Auditorium Paris

20 – 22 November 2014Georges Pompidou European

HospitalParis, France

43

AND ONE MORE USEFUL WEBSITE

http://qualityoflife.elsevierresource.com/

44

AND OF COURSE PLEASE COME TO THE

NEXT

NICSO MEETING!

NICSO 2014

CONCLUSION

SUPPORTIVE AND PALLIATIVE CAREARE

COMPLEMENTARY AND ESSENTIAL IN CANCER PATIENT TREATMENT

MATTI S. AAPROGENOLIER, SWITZERLAND