Current landscape of combined oncology/palliative care training in the United States.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 68-68 ◽  
Author(s):  
Ramy Sedhom ◽  
Arjun Gupta ◽  
Thomas J. Smith ◽  
Arif Kamal
Keyword(s):  
Palliative Care ◽  
Health Systems ◽  
Medical Oncology ◽  
The United States ◽  
Cancer Therapies ◽  
Early Integration ◽  
Key Stakeholders ◽  
Oncology Care ◽  
Care Training ◽  
New Cancer Therapies

68 Background: Recent calls by ASCO and others recommend early integration of oncology and palliative care. The rapid growth of new cancer therapies (e.g. immunotherapy) and their associated side effects and prognostic uncertainty suggest the need for oncologists to have palliative care sub-specialization. Despite the logical integration of oncology and palliative care training, the current landscape of ACGME training programs for these fields is unknown. Methods: We explored the ERAS Fellowship Website (https://www.aamc.org/services/eras/) on June 15, 2019, and collected information on Medical oncology, Medical Oncology/Hematology, and Hospice and Palliative Medicine (HPM) Programs. We identified institutions/ health systems that offered both Medical Oncology and HPM programs. We also identified institutions/ health systems that offered other Fellowships combined with Medical Oncology. We validated information by verifying each training program's website. Results: 152 unique programs offered Medical Oncology fellowship (144 combined with hematology) and 131 unique programs offered HPM fellowship. 7 Medical Oncology programs had tracks that allowed combination with geriatrics or infectious disease. 73 unique institutions/ health systems offered both Medical Oncology and HPM training separately, but no programs offered a combined Medical Oncology/ HPM track. Conclusions: Despite the call to better integrate palliative care in oncology care, we did not find any published descriptions of tracks combining Medical Oncology and HPM training. Successful examples of integrating Medical Oncology with other disciplines such as geriatrics exist. Trainees may still forge their own pathway and do sequential fellowships in Medical Oncology and HPM, but investment by key stakeholders is essential to pilot novel educational programs to address workforce issues in this field. It remains unknown how many programs accommodate combined or sequential training for interested applicants, or how they are funded.

Mikor és hogyan integráljuk az onkológiai és a palliatív ellátást?

2021 ◽  
Vol 162 (44) ◽  
pp. 1769-1775
Author(s):  
Orsolya Horváth ◽  
Enikő Földesi ◽  
Katalin Hegedűs
Keyword(s):  
Palliative Care ◽  
Care Providers ◽  
Yale University ◽  
Early Integration ◽  
Advantages And Disadvantages ◽  
Referral Criteria ◽  
Number Of Patients ◽  
Oncology Care ◽  
The Right

Összefoglaló. A palliatív ellátások korai bevonása az onkológiai betegek ellátásába előnnyel jár mind a beteg életminősége, mind a kezelés színvonala, mind a költséghatékonyság szempontjából. Szükség van egy olyan modellre, mely alapján a megfelelő időben, a megfelelő beteg a megfelelő minőségű palliatív ellátásban részesül. Ebben a közleményben a palliatív ellátás korai integrációjának előnyei, szintjei és a speciális palliatív ellátás fogalmának ismertetése után a leginkább elterjedt beutalási modellek előnyeit és hátrányait mutatjuk be a nemzetközi szakirodalom alapján. A speciális palliatív ellátást igénylő betegek kiszűrésére szolgáló, prognózisalapú modellek hátránya, hogy nincs elég kapacitás az ilyen módon beutalt nagyszámú beteg ellátására, ezért széles körben nem terjedtek el. A tüneteken alapuló modellek sokszor bonyolultak és a mindennapi klinikai gyakorlatban nem használatosak. Az új kutatások alapján egyszerű, gyakorlatias kérdéssorokat alkalmaznak, melyekkel könnyen kiemelhetők, akik profitálnak a speciális palliatív intervencióból. Ezek közül a Yale egyetemi és a PALLIA -10 modellt ismertetjük részletesen. Amennyiben az aktív onkológiai ellátást végzők a megfelelő palliatív beutalási kritériumokat ismerik és alkalmazzák, a betegek időben jutnak a megfelelő komplex kezeléshez anélkül, hogy a palliatív ellátórendszer túlterhelődne. Orv Hetil. 2021; 162(44): 1769–1775. Summary. Early integration of palliative care into the trajectory of cancer care brings advantages into the patients’ quality of life, the level of care and cost-efficiency, too. On the basis of a predefined model, the right patient may receive the right level of palliative care at the right time. Having defined the advantages, the levels of early integration of palliative care and the concept of special palliative care, we also aim to describe the advantages and disadvantages of the most common referral models on the basis of international literature in this article. The drawback of prognosis-based models to identify patients needing special palliative care is the lack of capacity to provide care for the large number of patients so recognised; therefore they have not become widespread. Needs-based models tend to be complicated and thus rarely applied in everyday clinical practice. On the basis of new researches, simple, pragmatic questionnaires are utilised through which the patients who could benefit from special palliative care interventions are easy to identify. Here we give a detailed report of the Yale University and PALLIA-10 models. On condition that appropriate palliative referral criteria are known and applied by active oncology care providers, patients may receive adequate complex care without the palliative care system being overloaded. Orv Hetil. 2021; 162(44): 1769–1775.

scholarly journals Early Integration of Palliative Care in Oncology Practice: Results of the Italian Association of Medical Oncology (AIOM) Survey

2016 ◽  
Vol 7 (14) ◽  
pp. 1968-1978 ◽  
Author(s):  
Vittorina Zagonel ◽  
Riccardo Torta ◽  
Vittorio Franciosi ◽  
Antonella Brunello ◽  
Guido Biasco ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Oncology ◽  
Early Integration ◽  
Italian Association ◽  
Oncology Practice

Patients’ perceptions of early palliative oncology care: A qualitative analysis.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 138-138
Author(s):  
Breffni Hannon ◽  
Nadia Swami ◽  
Monika K. Krzyzanowska ◽  
Natasha B. Leighl ◽  
Amit M. Oza ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Medical Oncology ◽  
Controlled Trial ◽  
Comprehensive Cancer Center ◽  
Theory Approach ◽  
Early Referral ◽  
Early Palliative Care ◽  
Oncology Care ◽  
The Impact

138 Background: Early palliative care referral is encouraged for patients with advanced cancer. However, little is known about patients’ perceptions of the impact and relevance of early referral. We conducted a qualitative study in which patients with advanced cancer were interviewed following completion of a randomized controlled trial comparing early palliative care with standard oncology care. Our aim was to delineate what, in the opinion of patients, were the respective roles of the oncology and palliative care teams in an outpatient setting. Methods: We conducted qualitative interviews with patients following completion of a cluster randomised controlled trial of early versus routine palliative care referral. Participants were recruited from 24 medical oncology clinics at a comprehensive cancer center. Selective sampling was employed to ensure equivalent numbers of participants from intervention vs. control arms, male vs. female, age ≥60 vs. <60 years, with high vs. low self-reported quality of life, and with high vs. low satisfaction with care. Forty-eight patients (26 intervention and 22 control) with advanced lung, breast, gynecological, gastrointestinal and genitourinary cancers completed interviews lasting 25 to 90 minutes. Control patients were asked about the role of oncology; intervention patients were asked about both teams. Interviews were recorded, transcribed and analysed using NVivo. A grounded theory approach was used to explore emerging themes. Results: Several themes emerged in relation to the contrast between oncology (OC) and palliative care (PC) including (1) the focus of the consultation, with OC tending to focus on cancer or treatment options while PC was regarded as being more holistic, including physical, psychological and family domains; (2) the model of care delivery, with OC described as being clinician-led and time-limited, in contrast with PC where time was more flexible and the patient set the agenda; and (3) the complementary nature of early palliative care alongside standard oncology care in terms of overall well-being. Conclusions: From a patient perspective, palliative care and medical oncology have distinct and complementary roles, supporting the relevance of early referral.

Patients’ perceptions of early palliative oncology care: A qualitative analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20639-e20639
Author(s):  
Breffni Hannon ◽  
Nadia Swami ◽  
Monika Krzyzanowska ◽  
Natasha B. Leighl ◽  
Amit M. Oza ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Medical Oncology ◽  
Controlled Trial ◽  
Comprehensive Cancer Center ◽  
Theory Approach ◽  
Early Referral ◽  
Early Palliative Care ◽  
Oncology Care ◽  
The Impact

e20639 Background: Early palliative care referral is encouraged for patients with advanced cancer. However, little is known about patients’ perceptions of the impact and relevance of early referral. We conducted a qualitative study in which patients with advanced cancer were interviewed following completion of a randomized controlled trial comparing early palliative care with standard oncology care. Our aim was to delineate what, in the opinion of patients, were the respective roles of the oncology and palliative care teams in an outpatient setting. Methods: We conducted qualitative interviews with patients following completion of a cluster randomised controlled trial of early versus routine palliative care referral. Participants were recruited from 24 medical oncology clinics at a comprehensive cancer center. Selective sampling was employed to ensure equivalent numbers of participants from intervention vs. control arms, male vs. female, age ≥60 vs. <60 years, with high vs. low self-reported quality of life, and with high vs. low satisfaction with care. Forty-eight patients (26 intervention and 22 control) with advanced lung, breast, gynecological, gastrointestinal and genitourinary cancers completed interviews lasting 25 to 90 minutes. Control patients were asked about the role of oncology; intervention patients were asked about both teams. Interviews were recorded, transcribed and analysed using NVivo. A grounded theory approach was used to explore emerging themes. Results: Several themes emerged in relation to the contrast between oncology (OC) and palliative care (PC) including (1) the focus of the consultation, with OC tending to focus on cancer or treatment options while PC was regarded as being more holistic, including physical, psychological and family domains; (2) the model of care delivery, with OC described as being clinician-led and time-limited, in contrast with PC where time was more flexible and the patient set the agenda; and (3) the complementary nature of early palliative care alongside standard oncology care in terms of overall well-being. Conclusions: From a patient perspective, palliative care and medical oncology have distinct and complementary roles, supporting the relevance of early referral.

Development of Required Postgraduate Palliative Care Training for Internal Medicine Residents and Medical Oncology Fellows

2004 ◽  
Vol 19 (2) ◽  
pp. 81-87 ◽  
Author(s):  
Douglas Ross ◽  
Deborah Shpritz ◽  
Carla Alexander ◽  
Kennita Carter ◽  
Martin Edelman ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Palliative Care ◽  
Medical Oncology ◽  
Internal Medicine Residents ◽  
Care Training

A Cost-Benefit Analysis of Using Evidence of Effectiveness in Terms of Progression Free Survival in Making Reimbursement Decisions on New Cancer Therapies

2014 ◽  
Vol 17 (1) ◽  
pp. 21-52 ◽  
Author(s):  
Warren Stevens ◽  
Tomas Philipson ◽  
Yanyu Wu ◽  
Connie Chen ◽  
Darius Lakdawalla
Keyword(s):  
Cost Benefit ◽  
Progression Free Survival ◽  
The United States ◽  
Illustrative Case ◽  
Cancer Therapies ◽  
Free Survival ◽  
Trade Offs ◽  
Life Years ◽  
Significant Difference ◽  
New Cancer Therapies

Abstract Payers increasingly require evidence of a statistically significant difference in overall survival (OS) for reimbursement of new cancer therapies. At the same time, it becomes increasingly costly to design clinical trials that measure OS endpoints instead of progression-free survival (PFS) endpoints. While PFS is often an imperfect proxy for OS effects, it is also faster and cheaper to measure accurately. This study develops a general cost-benefit framework that quantifies the competing trade-offs of the use of PFS versus that of OS in oncology reimbursement. We then apply this general framework to the illustrative case of metastatic renal cell carcinoma (mRCC). In the particular case of mRCC, the framework demonstrates that the net benefit to society from basing reimbursement decisions on PFS endpoints could be between $271 and $1271 million in the United States, or between €171 and €1128 million in Europe. In longevity terms, waiting for OS data in this case would result in a net loss of 3549–14,557 life-years among US patients, or 6785–27,993 life-years for European patients. While more stringent standards for medical evidence improve accuracy, they also impose countervailing costs on patients in terms of foregone health gains. These costs must be weighed against the benefits of greater accuracy. The magnitudes of the costs and benefits may vary across tumor types and need to be quantified systematically.

scholarly journals Early integration of palliative care services with standard oncology care for patients with advanced cancer

2013 ◽  
Vol 63 (5) ◽  
pp. 349-363 ◽  
Author(s):  
Joseph A. Greer ◽  
Vicki A. Jackson ◽  
Diane E. Meier ◽  
Jennifer S. Temel
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Early Integration ◽  
Care Services ◽  
Palliative Care Services ◽  
Oncology Care

Early palliative care integration trial: consultation content and interaction dynamics

2021 ◽  
pp. bmjspcare-2020-002419
Author(s):  
Nadine Kleiner ◽  
Sofia C. Zambrano ◽  
Steffen Eychmüller ◽  
Susanne Zwahlen
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
End Of Life ◽  
Positive Impact ◽  
Interaction Analysis ◽  
Physical Symptoms ◽  
Early Integration ◽  
Early Palliative Care ◽  
Interaction Dynamics ◽  
Oncology Care

ObjectivesEvidence for the positive impact of the early integration of palliative care (EPC) continues to grow. Less is known about how EPC improves patient and family outcomes, including the content of EPC consultations. Therefore, we aimed to better understand the content of EPC consultations including areas addressed, percentage covered per area and interaction style.MethodsAs part of a trial in which EPC in addition to oncology care was compared with oncology care alone, we audio recorded 10 interventions. The palliative care team led the interventions using SENS, a conversation structure, which stands for: Symptoms, End-of-life decision-making, Network and Support. We employed two approaches to analysis: the Roter interaction analysis system (RIAS) to analyse interaction dynamics and SENS as a framework for content analysis.ResultsPhysician–patient communication covered 91% of the interaction. According to RIAS, the consultations were evenly dominated between physicians and patients (ratio=1.04) and highly patient-centred (ratio=1.26). Content wise, rapport was the largest category covering 27% of the consultation, followed by decision-making (21%) and by symptom assessment/management (17%) including 8.1% for physical symptoms and 5.4% for psychosocial aspects. Network discussions covered 17%, and lastly, support for the family 7%.ConclusionsEPC consultations cover a variety of end-of-life topics while putting a high value in establishing rapport, developing a relationship with patients, and on providing reassurance and positive emotional talk. EPC consultations using predefined structures may guarantee that a minimum of important aspects are addressed in a way in which the relationship with the patient remains at the centre.

Supportive simultaneous care: A novel approach to frail cancer patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16553-e16553 ◽  
Author(s):  
Michela Quirino ◽  
Alessandra Cassano ◽  
Salvatore Corallo ◽  
Adriana Turriziani ◽  
Armando Orlandi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Clinical Benefit ◽  
Cancer Therapies ◽  
Care Providers ◽  
Median Length ◽  
Home Setting ◽  
Significant Saving ◽  
Early Integration ◽  
Novel Approach

e16553 Background: In the last decades, improvements in systemic therapies and advances in supportive and palliative care made pts, usually early referred to exclusive supportive care, suitable for integrated strategies of care. This approach responds to an increasing effort to integrate palliative care in the model of comprehensive cancer care. Its feasibility relies on cooperation between oncologists and palliative care providers along the period of disease until the death of the pt. We report the experience of our Simultaneous Care Unit in the period 2008-11. Methods: We observed 159 pts (76 M, 83 F), median age 72 years (29-95), affected by advanced solid tumors or hematological malignancies. All pts received assistance by the Simultaneous Care Unit (SCU) composed by oncologists, psychologists, palliative care providers, spiritual assistants. They all received palliative and supportive care in the home setting and cancer therapies as outpatient. All pts were monthly evaluated for clinical benefit, defined as follows: ESAS score decreasing from >4 to <4 cut points and PS ECOG decrease from ≥2 to <2. We also evaluated the rate of hospitalization as the number of pts requiring access to our Acute Palliative Care Unit (APCU) as inpatient for acute illness or uncontrolled symptoms. Costs analysis was performed on the basis of the DRG reimbursements. Results: The median length of simultaneous care was 88 days (95% C.I. 68.75-111.51). Clinical benefit rate was 63,5% (95% C.I. 55.96-71.09). Hospitalization rate was 23,27% (95% C.I. 16.63-29.91). Median length of hospitalization for each pt (until symptom improving or death, if occurred) was 22,5 days. Median cost for each pt hospitalized at our APCU was 4478 euros. Conclusions: Our experience within the SCU shows that the early integration of SC and active cancer treatments is effective. Our % hospitalization is lower than that reported by other authors in the same settings of pts (range 30-70%) with a significant saving of money. If confirmed in prospective pharmaco-economic studies, our data suggest that our model provides a high-quality assistance to frail patients and could be exportable also in other settings of chronic illness, potentially leading to a more wise way to use Health Care System resources.

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