Inaugural Guildford Supportive Care in Cancer Course
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1 Inaugural Guildford Supportive Care in Cancer Course SUPPORTIVE CARE OVERVIEW Declan Walsh 4 th November 2015
2 A BRIEF HISTORY OF MEDICINE 2000 BC HERE, EAT THIS ROOT 1000 AD THAT ROOT IS HEATHEN, SAY THIS PRAYER 1850 AD THAT PRAYER IS SUPERSTITION, DRINK THIS POTION 1940 AD THAT POTION IS SNAKE OIL, SWALLOW THIS PILL 1985 AD THAT PILL IS INEFFECTIVE, TAKE THIS ANTIBIOTIC 2000 AD THAT ANTIBIOTIC IS ARTIFICIAL HERE, EAT THIS ROOT!
3 DIAGNOSIS DEATH CURATIVE PALLIATIVE COMFORT
4 Art of Palliative Medicine Science of Oncology
5
6 Seven Randomized Controlled Trials Palliative Care Standard Oncologic Care Survival Quality of Life Outcomes: Cost Smith, JCO, 2012
7 What is Palliative Medicine? Clinical Skills 1. Communication 2. DecisionMaking 3. Complications 4. Symptom Control 5. Psychosocial Care 6. Care of the Dying 7. Care Coordination Walsh, AJHPM, 2011
8 The Crossroads Health Care Reform Rapid Growth in PM Quality Clinical Integration Going Upstream New Training Research Agenda Technology
9 HCAHP SCORES Cleveland Clinic: September 2011
10 Supportive Cancer Care (MASCC) 1970 New Cancer Drugs & Treatments 1980 Cancer: Treatable Curable 1987 First Supportive Care Meeting 1990 MASCC 1993 Supportive Care in Cancer Journal Rittenberg, JSCC, 2011
11 MASCC 1998 Antiemetic Guidelines 2000 Febrile Neutropenia Guidelines 2002 Definition 2006 Study Groups 2015 Global Membership: > 60 Countries Rittenberg, JSCC, 2011
12 Supportive Care in Cancer The prevention and management of the adverse effects of cancer and its treatment Management of physical & psychological symptoms and sideeffects across the continuum of the cancer experience from diagnosis through anticancer treatment to posttreatment care Enhancing rehabilitation, secondary cancer prevention, survivorship and endoflife care are integral to Supportive Care
13 Supportive Care & Palliative Medicine Clinical Supportive Palliative Communication Decision Making Symptom Control Complications Psychosocial Care of Dying Care Coordination
14 Supportive Care & Palliative Medicine Academic Supportive Palliative Clinical Services Specialty Accreditation Subspecialty Training Research
15 Supportive and Palliative Care Time for Unity in Diversity Palliation Ends or Support Starts? Continuum Multidisciplinary ESMO Integrated Centers OncPall Care Name Changes ASCO Clinical Opinion Aapro, Ann Oncol, 2012
16 The Cost Curve in Cancer Care $173B Direct Cancer Care Cost by Surveillance Testing & Imaging 2.Sequential Monotherapy v combination 3.Limit Chemotherapy by Perf Status 4. Reduce Chemo Doses in Met Solid Tumors 5. Symptom Directed Care» Smith, NEJM,2011
17 Palliative Medicine Supportive Care
18
19 Study Design AIDS Experience Representative Populations Recruitment & Attrition Randomized Controlled Trials Best Supportive Care Biostatistics Aktas, Sem Onc, 2011
20 Checklist Symptoms in Six Validated Instruments 2 Sore mouth 2 Memory problems 2 Dysphagia 2 Dizziness 2 Cough 2 Anxiety 3 Vomiting 3 Numbness/tingling 3 Drowsiness 3 Dry mouth 3 Depression 4 Constipation 5 Sleep problems 5 Nausea 6 Pain 6 Easy Fatigue 6 Dyspnea 6 Anorexia Questions/instrument Symptom Present in number of instrument MSAS RSCL EORTC QLQC30 MDASI SDS ESAS Symptom
21 CANCER COMPLICATIONS CARDIORESPIRATORY AUTONOMIC FAILURE GASTROINTESTINAL ANOREXIA CACHEXIA INFECTIONS SEPTICEMIA METABOLIC HYPERCALCEMIA MUSCULOSKELETAL PATHOLOGIC FRACTURES NEUROPSYCH COGNITIVE FAILURE
22 WEIGHT LOSS AND PROGNOSIS 22
23 ANDROGEN DEFICIENCY AIM Testosterone Deficiency Poor PS NonHormonal Ca METHODS Effect of Serum Free Testosterone on SixMinute Walk CONCLUSIONS Extreme Testosterone Walk Capacity Severe Testosterone Sustained Activity Gagnon, JPSM, 2013
24 CANNABINOIDS Triple Threat? 1. One Drug Multiple Symptoms Low S/E 2. AntiProliferative & Cytotoxic 3. Treatment Toxicities
25 Laboratory Research: New Paradigm Animal Models Clinical Pharmacology Cytokines Endocrine Nutrition Nanomedicine
26 PATHOPHYSIOLOGY Pain Depression Fatigue Proinflammatory Cytokines Cleeland, Cancer, 2003 Anorexia SatietyNausea Autonomic Dysfunction Walsh, Supp Care Cancer, 2006 Anorexia Fatigue Insomnia Hypothalamic Signal Disruption Rich, J Support Oncol, 2007
27 14/10/
28 Brain 3D Image Gamma Signals At Rest Control CRF
29 Airway Stents Casal, COPM, 2010
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