1 Integration of palliative care into oncology Stein Kaasa European Palliative Care Research Centre, Faculty of Medicine, NTNU and Department of Oncology, St. Olavs Hospital, Trondheim University Hospital Trondheim, Norway
2 Several challenges for cancer care Incidence Prevalence Treatment complexity Expectations in the society
3 Cancer incidence in Norway
4 The cancer burden 1 of 3 men will get cancer 1 of 4 women will get cancer 1 of 4 will die of cancer
5 The complexity and opportunities in cancer treatment has changed dramatically during the last 10-15 years
6 Advanced colorectal cancer As an example 1990: Surgery ± 5Fu ±
7
8 How to overcome the complexity? A more systematic approach may help
9 Standardised patient treatment trajectory Phase III randomised studies Standard treatment programmes Standard patient trajectories Clinical practice The best possible cancer care Highly qualified experts
10 Improvement of oncology care has happened over many years Many small steps over time Diagnosis/classification Treatment Surgery Radiotherapy Chemotherapy Treatments are systemized and evaluated
11 How may symptom management be improved in all parts of the patient trajectory? Follow-up Curative Life-prolonging treatment During treatment Palliative intervention Survivors Late side effects
12 More patients are Cured Living longer with metastatic disease Receiving prolonged end-of-life care Many patients will potentially experiencing late side effects from the targeted therapies
13 The health care system is getting more specialised Surgery Imaging Pathology Oncology Etc. Palliative (oncology) medicine?
14 Cancer care at tertiary (university hospital) level Surgery - perform specialised surgery Pathology - specialised in cancer Radiology - specialised in cancer Oncology - specialised in cancer subgroups Palliative medicine - also in the need of more specialisation?
15 1990 Curative Chemo-/radiotherapy Oncology care Lifeprolonging Symptomatic Palliative care End-of-life care
16 Curative Lifeprolonging Symptomatic End-of-life care 2010 Chemo-/radiotherapy Oncology care Competence Referral of patients Palliative care Collaboration Main responsibility
17 How to deal with these challenges? and how can palliative care contribute?
18 Curative treatment intention Lifeprolonging treatment intention Palliative treatment intention End-of-life care The competence Symptoms of palliative Loss of function care Psychological and social issues Existential/spiritual issues
19 How much specialization is needed in palliative care? At university hospitals In research? In clinical skills and knowledge?
20 Two education models Medical school Medical school Palliative medicine Oncology Palliative medicine
21 Integration of palliative care into oncology care Some practical suggestions to start with
22 Lung cancer Pulminologist Thoracic surgery Oncology Medical oncology Radiotherapy Pathology Radiology Breast cancer Breast cancer surgery Oncology Medical oncology Radiotherapy Pathology Radiology The palliative care team Palliative medicine Palliative care nursing Social worker Physiotherapist Psychologist
23 Key features to be fulfilled Common understanding and acceptance of the organisational structure The organisational structure needs to be incorporated at each institution All participants in oncology and palliative care teams need level three competence Communication and structure needs to be established, understood and followed The patients must be in the centre
24 The Norwegian health care system Hospital care Tertiary level-university hospitals Secondary level-local hospitals Community care Home care Nursing home care
25 The Trondheim model An almost total integration In the hospital St. Olavs University Hospital In the department of oncology In the region Local hospitals The community care
26 Clinical activities Virtually integrated Inpatient unit Outpatient unit Palliative care team Specialized nursing home units Nursing homes
27 Teaching and research Totally integrated Regional Centre for Competence in Palliative Care
28 Latest development Clinically More senior doctors to palliative care More beds to palliative care (12 to 16) More patients to palliative care More home visits and visits to nursing homes
29 Latest development Research Translational research - ongoing Integration of palliative care and late side effects research Symptom effects of tumour directed treatments Radiotherapy Chemotherapy
30 Latest development Research cont. Large scale European multicentre studies Pain Cachexia Pain effects and mechanisms; radiotherapy
31 Ongoing work Standardized treatment trajectories for all cancer diagnosis Palliative care incorporated in all
32 We will achieve Better curative and life prolonging treatment by improved focus Surgery Medical and radiation oncology Community care Palliative care specialists do what they are best at Improved cost effectiveness
33 prc@ntnu.no