cure simultanee in oncologia -...
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Regione del Veneto
CURE SIMULTANEE IN ONCOLOGIA
Vittorina Zagonel Dipartimento di Oncologia Clinica e Sperimentale
Oncologia Medica 1, IOV-IRCCS, Padova
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CURE SIMULTANEE
Integrazione tra le terapie oncologiche
attive e le cure palliative*
dal momento della presa in carico
del paziente oncologico.
* Prevenzione, identificazione, valutazione e trattamento dei sintomi fisici, funzionali e dei problemi psicosociali e spirituali del malato nella fase
avanzata-terminale di malattia, quando l’outcome non è più la sopravvivenza. AIOM Tumori 95:652-654, 2009.
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CURE SIMULTANEE IN ONCOLOGIA
“Le cure palliative iniziano
quando inizia la sofferenza del
malato e dei familiari”^.
^E. Bruera Lectio magistralis, Bentivoglio 2011.
TERAPIE ANTITUMORALI
CURE PALLIATIVE
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Potential palliative interventions
across the care continuum.
Hennessy J E et al. JOP 2013;9:78-80
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INDIVIDUALIZED PATIENT-CENTERED CARE
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Vicenza Venezia L’Aquila
Roma FBF
2004-2005
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Cure Simultanee: le tappe
• 2008: istituzione task force “Cure palliative in oncologia”con i referenti dei centri ESMO accreditati
• 2009: Position Paper AIOM tumori
• Gruppo di lavoro Ministero legge 38/2010
• Tavolo di lavoro permanente “Continuità di cura”
• Progetto master & back (MD Anderson)
• Linee guida terapia del dolore e malnutrizione
• 2012:Presenza nel WG ESMO palliative care
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Tavolo di lavoro “Continuità di cura in Oncologia”
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Dal Curare al
PRENDERSI CURA
DAL CURARE AL PRENDERSI CURA
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Cure Simultanee:le tappe
• 2013 indagine ESOPO dolore
• 2013 questionario soci sulle CS
• 2013 CONFERENZA NAZIONALE sulle CS
• 2014 documento di consenso sulle CS
• 2015:tavolo di lavoro AIOM-SICP
• 2015:inserimento CS in LG polmone
• 2016 inserimento CS in LG pancreas e altre patologie
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IV corso residenziale AIOM continuità di cura in oncologia Roma 30-31 marzo 2012
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Tavolo di lavoro :Pubblicazioni
• 1° doc. AIOM Tumori 2009
• Documento di consenso Tumori 2015
• Esito questionari sub
• Dolore ESOPO BJC 2015
• Raccomandazioni nutrizione sub.
• Raccomandazioni nutrizione sito AIOM
• Documento AIOM-SICP 2015 sito AIOM
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Tavolo:Protocolli di ricerca
•Maltoni
•Maltoni
•Broglia
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“L’offerta clinico assistenziale per i percorsi di fine vita va riproposta con una logica di sistema che riconosce come punto di partenza la condivisione dei
percorsi, già a partire dalla fase di cura attiva”.
“Il sistema deve garantire il percorso di cure palliative che inizia all’interno del percorso di trattamento oncologico e coesiste con esso, proiettandosi
fisicamente al di fuori delle mura degli ospedali, verso la rete di cure palliative”.
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Congresso ESMO , Vienna 2015
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Congresso ESMO , Vienna 2015
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There is a clear evidence for improved
outcomes in multiple domains:
1. symptoms
2. quality of end-of life care
3. provider satisfaction
4. cost of care
SIMULTANEOUS CARE
Ramchandran K et al Oncology 27:1-18, 2013
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CURE SIMULTANEE-IOV
• Palliativista :12/2011
• Attivazione breefing reparto : 1/2012
• Accreditamento ESMO: 9/2012
• Ambulatorio cure simultanee:6/2012
• Inserimento cure simultanee nei PDTA ROV di patologia:2015-2016
• Riaccreditamento ESMO (tutto il dipartimento) : 9/2015
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PATIENT PALLIATIVE
CARE
RESEARCH
VOLUNTEER
TRIALS
SIMULTANEOUS CARE CLINIC
PHSYCHOLOGIC SUPPORT
SETTING of
CARE
IOV-Comprehensive Cancer Center PADOVA
MULTIDISCIPLINARY TEAMS
ONCO-GERIATRIC CLINIC
ONCO-BONE CLINIC
General Practitioner
TRAINING
National & International
Networks
GI
Breast Lung Uro
Brain Gynecologic
Sarcomas Melanoma
H&N Limphomas
Tyroid others
Oncologist Geriatritian
Radiologist Oncologist Palliativist
Radiotherapist Spine surgeon
Endocrinologist
Oncologist Palliativist
Psychologist Nutritionist
Nurse
Hospice
Home Care Services
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Electronic Medical Report
Palliativista Nutrizionista Psicologo
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CURE SIMULTANEE-IOV
• Criteria for selection of patients with metastatic disease:
• KPS <= 60 or: • Symptomatic disease (pain, occlusion) or: • Prognosis <= 6 months, or: • Psychological problems / depression or: • Significant weight loss • Any patient who in the opinion of the oncologist require assessment for supportive care.
• Weekly multidisciplinary clinic
• Signaling the patient to local services
for taking charge
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Dynamic model of palliative care.
Partridge A H et al. JCO 2014;32:3330-3336
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Indicators of integration of oncology and palliative care programs:an international consensus. I
1. Presence of palliative care inpatient consultation team
2. Presence of palliative care outpatient clinic
3. Presence of interdisciplinary palliative care team
4. Routine symptom screening in the outpatient oncology clinic
5. Routine documentation of advance care plans in patients with advanced cancer
6. Early referral to palliative care
7. Proportion of outpatients with pain assessed on either of the last two visits before death
Hui D et al. Ann Oncol July 9, 2015
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Indicators of integration of oncology and palliative care programs: an international consensus. II
8. Proportion of patients with 2 or more emergency room visits in last 30 days of life (-)
9. Place of death consistent with patient's preference
10. Didactic palliative care curriculum for oncology fellows provided by palliative care teams
11. Continuing medical education in palliative care for attending oncologists
12. Combined palliative care and oncology educational activities for fellows/trainees
13. Oncology fellows have routine rotation in palliative care
Hui D et al. Ann Oncol July 9, 2015
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Clinical Pathway CRC