Developing Supportive Care in Serbia
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1 Developing Supportive Care in Serbia Prof Snežana Bošnjak Institute for Oncology and Radiology of Serbia National Cancer Center Dept. Supportive Oncology & Palliative Care ESO & ESMO Faculty member
2 Faculty Disclosure X No, nothing to disclose Yes, please specify: Company Name Honoraria/ Expenses Consulting/ Advisory Board Funded Research Royalties/ Patent Stock Options Ownership/ Equity Position Employee Other (please specify) Helsinn Healthcare x X Angelini Pharma X
3 Our vision All patients and their families will receive the support and care they need to cope with cancer and its treatment
4 Our mission To integrate: ü Disease-directed and patient & familydirected interventions ü Supportive & palliative care in routine cancer care at the IORS
5 Managing change SEE unfulfilled needs of patients to get help for symptoms / toxicities BELIEVE in integrated care Act to create CHANGE by offering supportive care consultations
6 Chemotherapy-induced nausea & vomiting (CINV)
7 CT-induced nausea & vomiting See an unfulfilled need Plastic bowls for vomiting Believe you can make a difference Improve CINV prevention & control with the appropriate use of antiemetics Act to create change Antiemetic consultations
8 CT-induced nausea & vomiting Improve professional expertise Journal of Supportive Care in Cancer: the MASCC journal MASCC membership (1993) Find your bright spots MASCC experts: F.Roila, J. Herrstedt, R.Gralla Improve availability of & access to antiemetics
9 ...CT induced nausea & vomiting Participation of the IORS in the CINV clinical trials: ü The Italian Group for Antiemetic Research ü MASCC Study Group on antiemetics Obtain: ü the best antiemetics for our patients ü the protocols for CINV prevention & control
10 The change: CINV MASCC guidelines & tools translated Booklets for HC professionals & patients published Antiemetics are part of CT protocols Vomiting bowls disappeared!
11 Cancer pain
12 Cancer pain... See an unfulfilled need: Patients suffering in silence Believe you can make a difference Cancer doesn t have to be painful WHO principles for the use of analgesics translated & implemented Act to create change Cancer pain consultations for in- and outpatients
13 ...Cancer Pain Improve professional expertise: MASCC experts in pain & palliative care MASCC Palliative Care Study Group Find your bright spots University of Sheffield: Sam Ahmedzai MD Anderson Cancer Center: Eduardo Bruera Improve availability of & access to opioids International Pain Policy Fellowship Access To Opioid Medicines Europe (ATOME) project
14 The change: Cancer Pain Raised awareness & improved knowledge Improved availability of & access to opioids Less restrictive pain policies The right to pain relief & relief of suffering recognized as a patient s right Bosnjak SM et al., J Pain Symptom Manage 2016;52:
15 Integrative Oncology Supportive Care Service Institute For Oncology & Radiology Belgrade, Serbia
16 Conceptual Framework: Supportive and Palliative Care Supportive care Palliative care Hospice care No evidence of disease Curable cancer Incurable cancer Bereavement Death Conceptual framework for supportive care, palliative care and hospice care, based on the systematic literature review. Hui D, Bruera E. Nat Rev Clin Oncol 2016; 13:
17 Sheffield model of integrative care Supportive care Screening Investigation Remission Diagnosis Cure Remission Disease-directed therapy Survivorship Relapse Co-morbidity Information -- Side-effects --- Rehabilitation Patient-directed therapy Death Information --- Psychological support --- Financial help Family-directed therapy Grief / Bereavement Adapted from: Ahmedzai, Walsh Seminars in Oncol 2000
18 Integrative Oncology (ESMO) The oncologist role is not only to deliver the best quality anticancer treatment but also to consider the impact of the disease and treatment on each patient s life ESMO position statement on supportive and palliative care Jordan K, et al., Annals of Oncology 29: 36 43, 2018
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20 Dept. Supportive Oncology & Palliative Care Mobile Consultation team for inpatients: daily ward rounds Supportive Care Unit: 4 beds EDUCATION Clinical rotations CME Guidelines Conferences RESEARCH Projects Clinical trials Publications PROs Outpatient service for pain & supportive care
21 Supportive Oncology Unit
22 Out-patient service Pain & supportive care Every working day (10-13h) Scheduled & as needed appointments 4 physicians / 2 nurses Collaborates closely with the MTB patients per week
23 Education in supportive care
24 Research publications CINV Roila F, et al. N Engl J Med, 2000, 342: Roila F, et al for The Italian Group for Antiemetic Research. J Clin Oncol, 2004, 22: Hesketh PJ, et al. Support Care Cancer, 2011, 19: Gralla R, et al. Ann Oncol 2014, 25: Hesketh PJ, et al. Biomed Res Int Bosnjak S, Dimitrijevic J, Djordjevic F. Curr Opin Support Palliat Care 2016, 10: Bošnjak SM, Gralla RJ, Schwartzberg L. Support Care Cancer, 2017,25(5), Aapro M, et al. J Geriatr Oncol : Cancer pain & palliative care Bruera E, et al. J Clin Oncol, 2004, 22: Bruera E, et al. J Pain Symptom Manage 2004, 28: Bošnjak S, et al. Support Care Cancer, 2011, 19(8): Bošnjak SM, et al. J. Pain Symptom Manage 2016, 52:
25 Advocating for Supportive Care Leadership skills Strategic planning Presentation skills Negotiation skills Messaging skills Public speaking and media skills The International Palliative Care Leadership Development Initiative, USA
26 Belgrade Educational Meeting on Supportive Care for Eastern Europe and the Balkan region
27 Belgrade regional meeting Promote supportive care (SC) in Eastern Europe & Balkan Region (EEBR) Facilitate integration of supportive care into oncology Discuss regional situation & barriers to optimal supportive care Create a collaborative network of local champions
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29 Educational Format Plenary lecture: the MASCC President Supportive Care Makes an Excellent Cancer Care Possible Opening lectures: 2 models of the integrated SC service in 2 countries Symptoms and toxicities: promotion of available SC guidelines Meet the expert: implementation of SC guidelines through case discussion & problem solving Workshop: challenges for optimal SC in EEBR
30 Participants & Faculty 180 participants & lecturers, 18 countries Distinguished Faculty: 4 Presidents of MASCC Evaluation (1: poor to 4: excellent) Overall learning outcome: 3.76 / 4 Content: a) relevant to clinical work: 3.62/4; b) well-balanced /evidence-based: 3.72/4 c) the time provided for discussion / Qs: 3.75/4
31 Conclusion Mind the gap between the needs of patients and the actual provision of care Believe you can make a difference Act to create change Find bright spots : the MASCC Change the culture of care
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