Supportive Care For Hematological Malignancies

Transcription

1 Supportive Care For Hematological Malignancies Nawaf Alkhayat, MD Pediatric Hematology, Oncology & BMT Prince Sultan Military Medical City Riyadh, KSA

2 Supportive care Definition Why we need supportive care? Cost of supportive care Guidelines and adherence Best location Designing of treatment units & Easy access Satellite services, home care Religious factors Government financial aids Age groups Long term follow up programs Palliative care & hospice care Educational programs Research gap 2

3 Not 1 man show! 3

4 WHO, When, What 4

5 Definition the provision of the necessary services for those living with or affected by cancer to meet their informational, emotional, spiritual, social or physical need during their diagnostic treatment or follow-up phases encompassing issues of health promotion and prevention, survivorship, palliation and bereavement What is supportive care? Can Oncol Nurs J. 1994;4:

6 Definition...In other words, supportive care is anything one does for the patient that is not aimed directly at curing his disease but rather is focused at helping the patient and family get through the illness in the best possible condition. Clearly this type of help would need to be broad in scope and as varied as the individuals requiring it What is supportive care? Can Oncol Nurs J. 1994;4:

7 Supportive care is for 7

8 Medical Supportive Care Disease & treatment Febrile Neutropenia Tumor Lysis Syndrome Organ dysfunction Emergencies The Acute Abdomen Thrombotic Disorders Pain Management Nausea and Vomiting Oral Mouth Care and Mucositis Nutrition Radiation Side Effects Prevention of Infection Hematopoietic Growth Factors Central Venous Catheters Care Transfusion Support 8

9 Why we need supportive care? How can we convince the decision maker about it? 9 story

10 10 Pediatr Blood Cancer 2012;59: , Improved Outcome in Pediatric AML Due To Augmented Supportive Care. Wasil Jastaniah, et al

11 Era1 From 1996 to 2002 (era1), supportive care strategies included Hickman catheters, blood products, antibiotics, antiemetics, mouth and skin care, and antifungal prophylaxis Era2 environmental measures including expert personnel and high-efficiency particulate air (HEPA) filtration. A Pediatric Oncology Walk-In Emergency Room (POWER) set up to provide 24-hour, 7 day a week emergency management. Unified febrile neutropenia protocol antimicrobial cultures and sensitivity patterns were reviewed every 2 years to optimize antimicrobial choice 11 Pediatr Blood Cancer 2012;59: , Improved Outcome in Pediatric AML Due To Augmented Supportive Care. Wasil Jastaniah, et al

12 12 Pediatr Blood Cancer 2012;59: , Improved Outcome in Pediatric AML Due To Augmented Supportive Care. Wasil Jastaniah, et al

13 Cost of supportive care Expenditures on cancer treatment, total and by type of service, 2001 (adjusted to 2011) & 2011 Source: US Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the 13 Medical Expenditure Panel Survey, 2001 and 2011

14 Cost of supportive care Mean expenditures on cancer treatment per person with expense, by type of service, 2001 (adjusted to 2011) and 2011 Source: US Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the 14 Medical Expenditure Panel Survey, 2001 and 2011

15 Guidelines and adherence, FN Research gap Compliance Outcomes 41.5% Fully Compliant (6) 6.2% ICU transfer 40.0% Partially Compliant (4-5) 4.6% inpatient mortality 18.5% Non-compliant (0-3) 4.6% adverse antibiotic reaction 9.2% Clostridium difficile, 90 days 7.7% new VRE, 90 days (60% infection; 40% colonization) Retrospective Analysis of Compliance in Guideline-Based Management of Neutropenic Fever. M J Hoffman, et al 15

16 Guidelines and adherence, FN 16 Retrospective Analysis of Compliance in Guideline-Based Management of Neutropenic Fever. M J Hoffman, et al

17 Guidelines and adherence, FN Despite FN guidelines, compliance is poor mainly driven by vancomycin overuse In light of the relatively high rate of adverse drug reactions, new Clostridium difficile and VRE cases, further intervention is needed to improve compliance with established NF guidelines Retrospective Analysis of Compliance in Guideline-Based Management of Neutropenic Fever. M J Hoffman, et al 17

18 Guidelines and adherence, CINV Reported barriers/reasons interfering with using guideline-recommended antiemetics Highly HEC, Moderately MEC: emetogenic chemotherapy CINV and adherence to antiemetic guidelines, Rebecca Clark-Snow, Supportive Care in Cancer, February 2018, Volume 26, Issue 2, pp

19 Where it can be delivered? 19

20 Best location Research gap ER vs OPD vs Daycase vs In-patient 20

21 Design Design of treatment units should address the need of the special population Dedicated center vs hospital department Research gap 21

22 Dedicated center vs hospital dept. 22

23 Easy access where Satellite services home care Research gap 23

24 Clinic nurse vs Electronic Booking an appointment Report symptoms Report death Full HIS 24

25 financial aids The Financial Toxicity of Cancer Treatment, Zafara, et al, THE ONCOLOGIST February 26, 2013

26 We can

27 Religious factors Research gap Cancer 2015;121: R/S was associated with improved overall physical health (z , P <.001); this relation was not moderated by socio-demographic or clinical variables. associated with physical well-being (z , P <.001), functional well-being (z , P <.001), and Physical symptoms (z , P <.001) greater religion/spirituality is associated with better patient-reported physical health 27

28 Religious factors Research gap Cancer 2015;121: Overall R/S was associated with overall physical health (z , P <.001); this relation was not moderated by sociodemographic or clinical variables. associated with physical well-being (z , P <.001), functional well-being (z , P <.001), and Physical symptoms (z , P <.001) greater religion/spirituality is associated with better patient-reported physical health 28

29 Age groups Pediatric, adults, geriatrics 29

30 Educational programs Research gap Vs WhatsApp 30

31 Long term follow up programs Research gap Cancer survivorship App: PROM (patient reported outcome measures) Organs dysfunction Fertility Depression - adolescent and young adult (AYA) 31

32 Palliative care & hospice care Research gap 32

33 What, when, who Research gap 33

34 34