palliative chemotherapy jason r. beckrow, do lighthouse oncology
TRANSCRIPT
Objectives
• Objectives:– Understand the concept of treat with curative
intent vs. palliative intent.– Discuss the therapeutic goals of palliative chemo– Discuss targeted and palliative drug for various
malignancies.
GeriPal: A geriatrics and Palliative Care Blog
• Is there anyone amongst the readership that can direct me to a list, a compendium of purely "palliative" chemotherapy regimens?
• You can't find a protocol because there is no such thing. Chemotherapy produces symptoms, usually more symptoms than it relieves….Annonymous
Patients Reported Oncology Teams Often Do Not:
• Consider psychosocial care as a part of their patients’ cancer care.
• Understand their psychosocial needs, know about resources, or refer when needed.
• President’s Cancer Panel 2003, 2004
Community Oncology Offices
Cancer-FreeSurvival
Managed Chronic or Intermittent
Disease
TreatmentFailure
Treatment withIntent to Cure
PalliativeMedicine
Diagnosis andStaging
Death
• Where majority of cancer care is given today
• Where fewest psychological and social
services available
IOM President’s Cancer Panel, 2003, 2004Slide Courtesy of Jimmie Holland, MD
Memorial Sloan Kettering Cancer Center
Conventional Care
PresentationPresentationPresentationPresentation DeathDeathDeathDeath
Anti-disease TherapyAnti-disease TherapyAnti-disease TherapyAnti-disease Therapy
BereavementBereavementCareCare
BereavementBereavementCareCare
6m6m6m6m
Hospice Hospice CareCare
Hospice Hospice CareCare
Model of palliative cancer care.
Ferris F D et al. JCO 2009;27:3052-3058
©2009 by American Society of Clinical Oncology
The Relief of Suffering
Physicians’ failure to understand the nature of suffering can result in medical intervention that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself.
Eric Cassel, 1982
The Goals of Palliative Chemotherapy
• Symptom Relief• Attainment of Life Goals• Portability• Accessibility • Cost efficiency • Your thoughts….
Early Palliative Care Study ProceduresPalliative Care Guidelines
Illness understanding and education Inquire about illness and prognostic understanding Offer clarification regarding treatment goals
Distress Management
Symptom management Pain Pulmonary symptoms Fatigue and sleep disturbance Mood Gastrointestinal
Decision-making Assess mode of decision-making Assist with treatment decision-making
Coping with life-threatening illness Patient Family/family caregivers
www.nationalconsensusproject.org
Oken, MM et al. Am J Clin Oncol 1982
…Principles of Oncology
Grade Activity0 Fully active, no restriction
1 Symptoms, restricted in strenuous activity
2 Ambulatory and capable of all self-care, no work activity. Up more than 50% of the day
3 Limited self care, confined to bed or chair >50% of the day
4 Completely disabled, unable to care for self, totally confined to bed or chair.
5 Dead
ECOG Performance Status
Conditions
• Breast Cancer• Lung Cancer• Prostate Cancer• Multiple Myeloma• Colo-rectal• Lymphoma
• Brain Mets• Bone Mets• Hypercalcemia• Chord Compression• SVC Syndrome• Hemoptysis
Breast Cancer
• Hormonal Therapy– Tamoxifen– Aromatase Inhibitors
• Her-2 Receptivity – Trastuzamab– Lapatnib
• Cyto-toxics– Taxanes