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

One of the first steps to early integrate palliative care into oncology practice is a timely and efficient evaluation of symptoms (Bakitas et al., 2015; Davis et al., 2015; Temel et al., 2010). In a recent position paper, the Italian Association of Medical Oncology tells oncologists that they “must be able to prevent, recognize, measure, and treat all cancer-related symptoms” (Zagonel et al., 2017). Major international scientific societies such as the American Society of Clinical Oncology and the European Society of Medical Oncology have often defined the key role of symptoms evaluation and management to force the integration of palliative care into oncology (Davis et al., 2015; Ferrel et al., 2017). Nevertheless, a recent survey conducted by the Italian Association of Medical Oncology shows that only 20% of oncologists regularly uses valid tools to evaluate symptoms, 45% exclusively use them in the context of clinical trials, 30% use them only occasionally, and 5% never use them (Zagonel et al., 2016).

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Position Paper of the Italian Association of Medical Oncology on Early Palliative Care in Oncology Practice (Simultaneous Care)

Tumori Journal ◽

10.5301/tj.5000593 ◽

2016 ◽

Vol 103 (1) ◽

pp. 9-14 ◽

Cited By ~ 7

Author(s):

Vittorina Zagonel ◽

Vittorio Franciosi ◽

Antonella Brunello ◽

Guido Biasco ◽

Chiara Broglia ◽

...

Keyword(s):

Palliative Care ◽

Medical Oncology ◽

Task Force ◽

Consensus Conference ◽

Organizational Models ◽

Early Integration ◽

Italian Association ◽

Early Palliative Care ◽

Medical Oncologists

One of the priorities of personalized medicine regards the role of early integration of palliative care with cancer-directed treatments, called simultaneous care. This article, written by the Italian Association of Medical Oncology (AIOM) Simultaneous and Continuous Care Task Force, represents the position of Italian medical oncologists about simultaneous care, and is the result of a 2-step project: a Web-based survey among medical oncologists and a consensus conference. We present the opinion of more than 600 oncologists who helped formulate these recommendations. This document covers 4 main aspects of simultaneous care: 1) ethical, cultural, and relational aspects of cancer and implications for patient communication; 2) training of medical oncologists in palliative medicine; 3) research on the integration between cancer treatments and palliative care; and 4) organizational and management models for the realization of simultaneous care. The resulting recommendations highlight the role of skills and competence in palliative care along with implementation of adequate organizational models to accomplish simultaneous care, which is considered a high priority of AIOM in order to grant the best quality of life for cancer patients and their families.

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How do they view us? Oncology providers’ perceptions of early/concurrent palliative care.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.114 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 114-114

Author(s):

Dilip Sankar Babu ◽

J Nicholas Dionne-Odom ◽

Lisa Zubkoff ◽

Tasha Smith ◽

Marie Bakitas

Keyword(s):

Palliative Care ◽

Survey Instrument ◽

Early Integration ◽

Early Palliative Care ◽

Care Intervention ◽

Before And After ◽

Anticancer Treatment ◽

Original Survey ◽

Oncology Practice ◽

Oncology Providers

114 Background: Early integration of palliative care has been increasingly recognized as an important component in the care of cancer patients, including during active anticancer treatment. Yet, palliative and supportive care interventions remain to be well integrated into standard oncology practice. We sought to develop an original survey instrument in order to describe oncology providers’ perceptions of palliative care, particularly when introduced in the early and concurrent setting. Methods: We conducted a systematic review of literature pertaining to perceptions of palliative care and barriers to referral, and extracted survey items where they were found. This pool of questions was narrowed to focus on early/concurrent palliative care, and supplemented with original items. The draft survey was then systematically validated using a standardized scoring system and content-validity approach. Results: Twenty-two studies were reviewed. From an initial pool of fifty items, twenty-nine were selected for the draft survey. The draft was then reviewed by ten oncology providers, who scored each item and provided comments. Conclusions: We have produced a fully validated survey instrument that will be used to characterize oncology providers’ perceptions of early and concurrent palliative care interventions. The validated survey will be administered to oncology clinicians (including nurses, social workers and chaplains) at four academic medical centers at which an early palliative care intervention is currently being implemented. We hope to assess perceptions before and after implementation of the early palliative care intervention.

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

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.31_suppl.68 ◽

2019 ◽

Vol 37 (31_suppl) ◽

pp. 68-68 ◽

Cited By ~ 1

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.

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Integrating Palliative Care into a Medical Oncology Practice

Oncology Issues ◽

10.1080/10463356.2014.11883949 ◽

2014 ◽

Vol 29 (4) ◽

pp. 20-26

Author(s):

Brian Bell ◽

Linda Harris ◽

Patricia Hegedus ◽

Kathy Lindsey

Keyword(s):

Palliative Care ◽

Medical Oncology ◽

Oncology Practice

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Essential competencies in palliative medicine for neuro-oncologists

Neuro-Oncology Practice ◽

10.1093/nop/npv011 ◽

2015 ◽

Vol 2 (3) ◽

pp. 151-157

Author(s):

Alissa A. Thomas ◽

Alan Carver

Keyword(s):

Palliative Care ◽

End Of Life ◽

Palliative Medicine ◽

Malignant Gliomas ◽

High Morbidity ◽

Survival Times ◽

Care Needs ◽

Early Integration ◽

Systemic Symptoms ◽

Oncology Practice

Abstract Palliative care is an approach to practicing medicine that addresses symptom management, alleviation of pain, assessment of psychosocial and spiritual distress or suffering, and practical support for patients and their caregivers with a goal of improving quality of life for patients with serious and life-threatening illnesses. Although palliative care has gained acceptance as an important part of comprehensive cancer care at the end of life, early integration of palliative care is less common. Patients with high-grade malignant gliomas have an invariably poor prognosis and high morbidity. With short survival times and complex neurological and systemic symptoms, these patients require palliative care from the time of diagnosis. In this review, we highlight the palliative care needs of neuro-oncology patients at diagnosis, during treatment, and at the end of life. We identify some of the barriers to incorporation of palliative care in standard neuro-oncology practice and equate competency in neuro-oncology with competency in the basic tenets of palliative medicine.

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Defining High-Quality Palliative Care in Oncology Practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement

Journal of Oncology Practice ◽

10.1200/jop.2016.010686 ◽

2016 ◽

Vol 12 (9) ◽

pp. e828-e838 ◽

Cited By ~ 61

Author(s):

Kathleen E. Bickel ◽

Kristen McNiff ◽

Mary K. Buss ◽

Arif Kamal ◽

Dale Lupu ◽

...

Keyword(s):

Palliative Care ◽

Advanced Cancer ◽

Palliative Medicine ◽

Medical Oncology ◽

Care Delivery ◽

Care Service ◽

Palliative Care Service ◽

Symptom Burden ◽

High Quality ◽

Oncology Practice

Purpose: Integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to specialist palliative medicine. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. Methods: An expert steering committee outlined 966 palliative care service items, in nine domains, each describing a candidate element of primary palliative care delivery for patients with advanced cancer or high symptom burden. Using modified Delphi methodology, 31 multidisciplinary panelists rated each service item on three constructs: importance, feasibility, and scope within medical oncology practice. Results: Panelists endorsed the highest proportion of palliative care service items in the domains of End-of-Life Care (81%); Communication and Shared Decision Making (79%); and Advance Care Planning (78%). The lowest proportions were in Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level, with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea, and pain. Within the Appropriate Palliative Care and Hospice Referral domain, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients appropriately. Conclusion: This statement describes the elements comprising high-quality primary palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find this information useful to inform operational changes and quality improvement efforts.

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