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Thursday, April 30, 2009

More on 'Palliative'

Cancer published an editorial to go along with the research paper about oncology clinicians' perceptions of 'palliative care' that Tom blogged about a while back. I can't say enough good things about this editorial and it rather succinctly sums the 'supportive' vs 'palliative' care debate in the oncology world, as well as contextualizes it in what 'real-life' is like on the ground. For instance:

Even in oncology centers where palliative care services exist, they are often underused. Only a limited proportion of patients with poorly controlled symptoms are referred for expert palliative care, and many patients are referred only very late in the history of their illness after having suffered from inadequately controlled physical or psychological symptoms for some time. There is compelling data to suggest that this problem is even more severe when the underlying malignancy is hematological in nature.
Most notable about the editorial was its discussion of recent events inside ASCO, of which I was unaware:
The getting-over-it approach is to continue to actively work to reduce and debunk the misconceptions and stigma associated with the term palliative care. This has been the approach of the ASCO board, which has recently endorsed a new policy statement on palliative cancer care. They have, in a very deliberate process, lent strong endorsement to the WHO definition and terminology. They define palliative cancer care as 'The integration into cancer care of therapies to address the multiple issues that cause suffering for patients and their families and have an impact on the quality of their lives. Palliative cancer care aims to give patients and their families the capacity to realize their full potential, when their cancer is curable as well as when the end of life is near.' Rather than shirking from the term palliative care, they have thrown their weight and credibility behind it in a further effort to educate clinicians and consumers about palliative care and to reduce stigma associated with the term. They want oncologists to confront stigma by communicating that the need for palliative care does not, in itself, conclude bad news; on the contrary, it infers the good news that optimizing quality of life is a priority of care for all patients. Kathleen Foley calls this 'getting real' about palliative care.
So some good news; we'll see if there are long-term implications of this.

Thanks to Dr. Bob Arnold for bringing this to my attention.

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