Matti Aapro MD Genolier, Switzerland Member of the ESMO Supportive Care Faculty

Transcription

1 «Spotlight» Case-based management of supportive and palliative care Matti Aapro MD Genolier, Switzerland Member of the ESMO Supportive Care Faculty Past-President of MASCC ( Multinational Association for Supportive Care in Cancer ) Honorary President of AFSOS (French-speaking Association for Supportive Care) Advisor to JASCC ( Japanese Association for Supportive Care in Cancer) Founding member of RASCC ( Russian Society of Supportive Care in Oncology )

2 COI Dr Aapro is/was a consultant for Amgen, BMS, Celgene, Clinigen, Eisai, Fresenius, Genomic Health, GSK, Helsinn, Hospira, JnJ, Novartis, Merck, Merck Serono, Pfizer, Pierre Fabre, Roche, Sandoz, Tesaro,Teva, Vifor, Voluntis and has received honoraria for lectures at symposia of Amgen, Bayer Schering, Biocon, Cephalon, Chugai, DRL, Eisai, Fresenius, Genomic Health, GSK, Helsinn, Hospira, Ipsen, JnJ OrthoBiotech, Kyowa Hakko Kirin, Merck, Merck Serono, Mundipharma, Novartis, Ono Pharmaceuticals, Pfizer, Pierre Fabre, Roche, Sandoz, Sanofi, Tesaro, Taiho, Teva, Vifor No responsibility accepted for involuntary errors or omissions. The list may be incomplete, and does not reflect consultancy for NGOs, Universities, Governmental agencies, and others

3 She also said it: Supportive Care Makes Excellent Cancer Care Possible D. Keefe Past-MASCC President

4 Online since Dec

5 MASCC Supportive Care in Cancer: 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 care givers helps cancer survivors with psychological and social problems

6 Palliative Care Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening ilness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. WHO 2002

7 About Astrid Notyoung Astrid is a past school teacher, an 80 year old widower. She has no significant personal or familial medical history. He has non-insulin dependent diabetes, treated with metformin, and hypertension that he neglects. She weighs 80 kg for 165 cm, does not smoke or drink except some Sekt at special occasions. Astrid lives at five minutes by foor from her sister Elda but never sees her. However Elda s son Anders ( now 61 ) comes often to play chess. Astrid is diagnosed with early breast cancer T1b, ER100%, PgR 95%, Her-2 neg. She accepts a tumourectomy, and refuses radiation. The oncology consultant suggests she is a good candidate for adjuvant hormonal therapy, and she accepts to take one pill per day, nothing more.

8 Would you discuss palliative care issues with her?

9 ASCO 2017

10 ASCO 2017

11 Let us be realistic JAMA Nov 2016

12 Let us be realistic Kavalieratos et al JAMA Nov 2016

13 RECOGNITION of the possible survival impact of Supportive ( «palliative» ) Care STARTED in

14 STARTED in 2010 When Jennifer Temel published her study in.. the NEJM..

15 «Early palliative care and NSCLC survival» Survie Globale Standard Care Early Palliative Care Temel J et al. NEJM

16 AND RECOGNITION CONTINUED with other papers but is still not convincing everyone?

17 What supportive care measures are relevant for her?

18 An example are the data on bisphosphonates in early breast cancer and survival

19 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. Published in Lancet Oncology 2014

20 Adjuvant bisphosphonates reduce the rate of bone metastasis and improve breast cancer survival in post-menopausal patients Bone Recurrence Breast Cancer Mortality EBCTCG Lancet 2014

21 Adjuvant AIs reduce the rate relapse and improve breast cancer survival in post-menopausal patients compared to tamoxifen EBCTCG Lancet 2015

22 Is cost consideration a barrier to follow this suggestion?

23 LESS RESOURCE UTILIZATION WITH CORRECT SUPPORTIVE CARE

24 Effect of Guideline-Consistent Therapy Pan European Emesis Registry (PEER) GCCP=guideline-consistent prophylaxis; GICP=guideline-inconsistent prophylaxis Aapro, Ann Oncol 23:1986, 2012

25 GUIDELINES REDUCE COSTS

26 GUIDELINES REDUCE COSTS

27 APPROPRIATE SUPPORTIVE CARE PROCEDURES or UNITS ARE COST-EFFECTIVE

28 APPROPRIATE SUPPORTIVE CARE PROCEDURES or UNITS ARE COST-EFFECTIVE

29 APPROPRIATE SUPPORTIVE CARE PROCEDURES or UNITS MAY IMPACT QOL, COSTS and SURVIVAL

30 Would you discuss a better communication with her?

31 ADHERENCE to HT Clinical Oncology , e9-e15doi: ( /j.clon ) Copyright 2017 The Royal College of Radiologists Terms and Conditions

32 Overall survival results of a randomized trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment (NCT ) Presented By Ethan Basch at 2017 ASCO Annual Meeting see also JAMA. 2017;318(2):

33 Study Hypothesis Presented By Ethan Basch at 2017 ASCO Annual Meeting

34 Slide 18 Presented By Ethan Basch at 2017 ASCO Annual Meeting

35 TO CONCLUDE Supportive and Palliative Care in Cancer - Multiple and Increasing Roles - SYMPTOM / SIDE EFFECT CONTROL QL PRESERVATION / IMPROVEMENT END-OF-LIFE CARE AFFECT SURVIVAL AND THE QUALITY OF THAT SURVIVAL PERMIT THE USE OF MOST EFFECTIVE ANTICANCER AGENTS IMPROVE ASSESSMENT OF BENEFIT FROM TREATMENT BETTER DESIGN OF CLINICAL TRIALS As discussed by R. Gralla at the TAO meeting in Paris on Thursday November 30, 2017

36 She and others were right: Supportive Care Makes Excellent Cancer Care Possible D. Keefe Past-MASCC President

37 SORRY I believe you are frustrated,

38 What an annoying lecture, does not help my practice at all

39

40 ONLINE February 2018 Free download from Annals or ESMO websites 40

41 ARE YOU HAPPY NOW? elines/supportiveand-palliative-care

42

43

44 Supplementary reading

45 ABOUT THE VALUE OF PROPER SUPPORTIVE AND PALLIATIVE CARE Aapro M.S. Editorial.Ann Oncol 2012 See also Temel JS et al NEJM 2010; 363: Zimmerman C et al Lancet Oncol 2013; 14: Bakitas et al. J Clin Oncol Ethan Basch, ASCO 2017

46 Study Design Presented By Ethan Basch at 2017 ASCO Annual Meeting

47 Results Presented By Ethan Basch at 2017 ASCO Annual Meeting

48 Quality of Life Presented By Ethan Basch at 2017 ASCO Annual Meeting

49 Slide 17 Presented By Ethan Basch at 2017 ASCO Annual Meeting

50 Costs/Resource Use Following CINV Therapy In a retrospective, observational, cohort study using a database to identify patients in US hospital-based facilities who received first-time HEC or MEC with 1 antiemetic agent during a 5-y period ( ) 1 in 8 patients had a CINV-associated follow-up hospital visit even though all received antiemetic prophylaxis 1 85% received a 5-HT 3 receptor antagonist, 76% dexamethasone, and 2% an NK 1 receptor antagonist 1 Vast majority of visits were for delayed CINV 1 Per-patient costs ranged from $891 for an ER visit after MEC to $7,678 for inpatient admission after HEC 1 Mean cost of hospital visit for CINV after first-time HEC or MEC was $731 1 HEC=highly emetogenic chemotherapy; MEC=moderately emetogenic chemotherapy. 1. Burke TA et al. Support Care Cancer. 2011;19(1): Resource utilization and costs associated with CINV following HEC or MEC administered in the US outpatient hospital setting 1 18% HEC 13% MEC Percentage of patients (N=19,139) experiencing any CINV-related outpatient visit, ER visit, or inpatient admission