Consensus document of the Italian Association of Medical Oncology and the Italian Society of Palliative Care on early palliative care

Abstract

A consensus document on early palliative care was produced by a committed Working Group of the Italian Society of Medical Oncology and the Italian Society of Palliative Care to improve the early integration of palliative care in medical oncology and to stimulate and guide the choices of those who daily face the problems of advanced stage cancer patients. The simultaneous administration of antineoplastic treatments and early palliative care was shown to be beneficial in metastatic cancer pathway outcomes. Patients who could benefit from early palliative care are those with an advanced cancer at presentation, a compromised PS for cancer, and/or morbidities, and who are too frail to receive treatment. According to the Bruera practice models, in which the combination of cancer management with early palliative care can be offered, three groups of patients needing simultaneous care were identified and three different models of the delivery of palliative care were proposed. In patients with good prognosis and low need of simultaneous care, the solo practice model and the request for consultations were suggested, while in patients with poor prognosis disease with high need of simultaneous care and in conditions with high need of simultaneous care, regardless of cancer prognosis, the integrated care approach should be offered. Palliative care consultation services are seldom accessible in the majority of Italian hospitals; thus the application of various practice models depends on available resources, and a shared care model with the structures of palliative care operating in the area is often required.

Palliative care: not only for treating symptoms: a case report

“…Both disciplines have become more complex and specialized over the years, and the integration of oncology and palliative care appears to be the key to improving the quantity and quality of life of cancer patients. 2,5,6,8…”

“…Oncology tends to focus on precision medicine, genomics, and prevention programs, whereas PC, intervening in a specific phase of the disease, encompasses patients and their families as part of the overall care project, fostering diagnostic and prognostic awareness, inviting active participation in the therapeutic decision-making process, and offering support in terms of spiritual and social well-being. 2,5,9…”

“…1 In a cancer setting, whereas PC was initially only hypothesized for use at end of life (EoL), it has now been proposed for use in the early phases of the disease (early PC [EPC]), thus representing a part of the cancer care continuum. 2 It has been seen that patients with advanced cancer who receive EPC have a better quality of life and reduced symptom burden. They also actively participate in the decision-making process, with a consequent reduction in indicators of EoL treatment aggressiveness with respect to those who receive PC on demand (i.e.…”

Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up of Exocrine Pancreatic Ductal Adenocarcinoma: Evidence Evaluation and Recommendations by the Italian Association of Medical Oncology (AIOM)

“…An unmet need for simultaneous care is evident in PDAC for its short life expectancy and for the impairment in QoL due to the influence of the disease-related symptoms and to the side effects associated with the treatment [ 67 ].…”

Forensic Toxicological and Medico-Legal Evaluation in a Case of Incongruous Drug Administration in Terminal Cancer Patients

“…In March 2010, a legislative decree was issued in Italy focusing on palliative care and pain therapy, also introducing the at-home sedation [4]. The Italian Society of Palliative Care underlines the opportunity for the physician to establish an efficient communication with both the patients and the relatives [5]. With respect to the deep sedation, the Italian Commission on Bioethics [6] suggested the following eligibility criteria for access to deep sedation: a patient with an incurable disease in an advanced stage, imminent death, the patient's consent, the presence of acute terminal events or symptoms refractory to treatment causing intolerable suffering to the patient.…”