The ESMO Palliative Care initiative. Nathan I Cherny Shaare Zedek Medical center Jerusalem, Israel. ESMO PC/SC Working Group. Established 1999 by ESMO national representatives Chair: Prof Raphael Catane A ctivities Policy Education Research Quality improvement.
Nathan I Cherny
Shaare Zedek Medical center
In advanced cancer
Unless oncologists take a lead role in the coordination and implementation of these aspects of care, we undermine our claim to be “cancer care” specialists.
Curable disease: Relapsed
Curable disease: Failed
EoLCare Integration with Disease Evolution
Medical oncologist must be skilled in effective and compassionate
communication with cancer patients and their families.
Specific skills include:
Medical oncologists must be expertin the evaluation and management of the complications of cancer including:
Medical oncologists must be expert in the evaluation and management of the common physical symptoms of advanced cancer including:
Medical oncologists must be familiar with the evaluation and management of the common psychological and existential symptoms of cancer including:
Medical oncologist must be familiar with research methodologies that are applicable to patients with cancer including:
MOs must be familiar with common ethical problems and ethical principles that assist in their resolution:
Private oncology practice 167 18.7% existential symptoms of cancer
Community hospital based 176 19.7%
Teaching hospital based 334 37.3%
Comprehensive cancer center 185 20.7%
Other………………………… 33 3.7%Practice Type
None 4 0.4% existential symptoms of cancer
A small proportion 78 8.7%
A substantial proportion 615 68.8%
Most of my practice 197 22.0%Proportion of my practice involved with advanced (incurable) cancer
often existential symptoms of cancer
A social worker 47.9
A home hospice (palliative care) team 37.8
A palliative care medical specialist 35.1
A psychologist 33.3
A palliative care nurse specialist 31.7
An inpatient hospice 26.4
A psychiatrist 14.9PC Collaboration
I received good training in PC during my oncology fellowship (residency)
I feel emotionally burned out by having to deal with too many deaths.
Most MOs I know are expert in the management of the physical and psychological symptoms of advanced cancer.
A palliative care specialist is the best person to coordinate the palliative care of patients with advanced cancer.
Palliative care (or Hospice) physicians don’t have enough understanding of oncology to counsel patients with advanced cancer regarding their treatment options.
The Center provides closely integrated oncology and palliative care clinical services
The Center is committed to a philosophy of continuity of care and non‑abandonment
The Center provides high level home care with expert backup and coordination of home care with primary cancer clinicians
The Center incorporates programmatic support of family members.Criteria for “Designated Centers”
The Center provides routine patient assessment of physical and psychological symptoms and social supports and has an infrastructure that responds with appropriate interventions in a timely manner
The Center incorporates expert medical and nursing care in the evaluation and relief of pain and other physical symptoms
The Center incorporates expert care in the evaluation and relief of psychological and existential distressCriteria for “Designated Centers”
The Center provides emergency care of inadequately relieved physical and psychological symptoms
The Center provides facilities and expert care for inpatient symptom stabilization
The Center provides respite care for ambulatory patients for patients unable to cope at home or in cases of family fatigueCriteria for “Designated Centers”
The Center provides facilities and expert care for inpatient end‑of‑life care and is committed to providing adequate relief of suffering for dying patients
The Center participates in basic or clinical research related to quality of life of cancer patients
The Center is involved in clinician education to improve the integration of oncology and palliative careCriteria for “Designated Centers”