Research Article
No access
Published Online: 2 July 2010

Implementing WHO Recommendations for Palliative Care into Routine Lung Cancer Therapy: A Feasibility Project

Publication: Journal of Palliative Medicine
Volume 13, Issue Number 6

Abstract

Background: The World Health Organization (WHO) explicitly recommends the integration of palliative care (PC) early in the disease trajectory as part of the WHO definition of PC. Our comprehensive cancer centre decided to include this recommendation in the administrative directives for principles of cancer care. The aim of this study was to assess, for patients with lung cancer, (a) at what point in the disease trajectory the patients were first provided PC and (b) whether - over one year - an earlier integration of PC could be achieved.
Objective: A retrospective systematic chart analysis of a two year period was performed. We assumed that seeing patients relatively early during the course of the illness would be reflected by seeing patients that would be not already (i) in a reduced performance status, (ii) experiencing symptoms that are indicators for advanced disease (e.g., dyspnoea and pain) and (iii) close to death. Therefore, the first PC consultation for every lung cancer patient was analyzed to assess in what physical condition patients receive first PC consultation, what burdening symptoms they already experienced and how long the patients lived after their first consultations.
Results: Most patients were already in a reduced physical state, were experiencing burdening symptoms and many died shortly after the first PC consultation. After a one year period, the number of burdening symptoms identified at first PC consultation and the admissions to the in-patient PC was decreased while non-PC physicians increasingly requested PC support for psychosocial interventions.
Conclusion: Though some degree of development towards a better understanding of PC competencies and the “early integration” approach could be demonstrated, the adoption of the WHO recommendation alone did not suffice to integrate PC into routine cancer care early in the course of the illness. Therefore, the development of disease specific guidelines is advocated by our working group.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
WHONational Cancer Control Programmes—Policies and Managerial Guidelines2ndGenevaWHO2002. 1. WHO: National Cancer Control Programmes—Policies and Managerial Guidelines, 2nd edition. Geneva: WHO, 2002.
2.
European Commission. Promoting the Development and Integration of Palliative Care Mobile Support Teams in the Hospital—The Fifth Framework Programme 1998–2002Quality of Life and Mangement of Living Resources2003. 2. European Commission: Promoting the Development and Integration of Palliative Care Mobile Support Teams in the Hospital—The Fifth Framework Programme 1998–2002. Quality of Life and Mangement of Living Resources. 2003.
3.
Buckholz GTvon Gunten CF. Nonpharmacological management of dyspneaCurr Opin Support Palliat Care2009398-102. 3. Buckholz GT, von Gunten CF: Nonpharmacological management of dyspnea. Curr Opin Support Palliat Care 2009;3:98–102.
4.
Lutz S et al. Symptom frequency and severity in patients with metastatic or locally recurrent lung cancer: A prospective study using the Lung Cancer Symptom Scale in a community hospitalJ Palliat Med20014157-165. 4. Lutz S, et al.: Symptom frequency and severity in patients with metastatic or locally recurrent lung cancer: A prospective study using the Lung Cancer Symptom Scale in a community hospital. J Palliat Med 2001;4:157–165.
5.
Radbruch L et al. [What is the profile of palliative care in Germany. Results of a representative survey]Schmerz200418179-188. 5. Radbruch L, et al.: [What is the profile of palliative care in Germany. Results of a representative survey]. Schmerz 2004;18:179–188.
6.
Radbruch L et al. What are the problems in palliative care? Results from a representative surveySupport Care Cancer200311442-451. 6. Radbruch L, et al.: What are the problems in palliative care? Results from a representative survey. Support Care Cancer 2003;11:442–451.
7.
Nauck F et al. Drugs in palliative care: Results from a representative survey in GermanyPalliat Med200418100-107. 7. Nauck F, et al.: Drugs in palliative care: Results from a representative survey in Germany. Palliat Med 2004;18:100–107.
8.
Ostgathe C et al. Differential palliative care issues in patients with primary, secondary brain tumoursSupport Care Cancer2009Epub ahead of print. 8. Ostgathe C, et al.: Differential palliative care issues in patients with primary and secondary brain tumours. Support Care Cancer 2009. (Epub ahead of print.)
9.
Altman D et al. Statistics with Confidence: Confidence Intervals and Statistical GuidelinesBMJ Books200050-54. 9. Altman D, et al.: Statistics with Confidence: Confidence Intervals and Statistical Guidelines. BMJ Books, 2000, pp. 50–54.
10.
R Development Core Team RA Language and Environment for Statistical ComputingVienna, AustriaR Foundation for Statistical Computing2009. 10. R Development Core Team R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing, 2009.
11.
Temel JS et al. Phase II study: Integrated palliative care in newly diagnosed advanced non-small-cell lung cancer patientsJ Clin Oncol2007252377-2382. 11. Temel JS, et al.: Phase II study: Integrated palliative care in newly diagnosed advanced non-small-cell lung cancer patients. J Clin Oncol 2007;25:2377–2382.
12.
Temel J. Complexities of quality of life analysis in non-small cell lung cancerJ Support Oncol2007530-31. 12. Temel J: Complexities of quality of life analysis in non-small cell lung cancer. J Support Oncol 2007;5:30–31.
13.
Weissman DEMeier DESpragens LH. Center to advance palliative care palliative care consultation service metrics: Consensus recommendationsJ Palliat Med2008111294-1298. 13. Weissman DE, Meier DE, Spragens LH: Center to advance palliative care palliative care consultation service metrics: Consensus recommendations. J Palliat Med 2008;11:1294–1298.
14.
Snow CE et al. Identifying factors affecting utilization of an inpatient palliative care service: A physician surveyJ Palliat Med200912231-237. 14. Snow CE, et al.: Identifying factors affecting utilization of an inpatient palliative care service: A physician survey. J Palliat Med 2009;12:231–237.
15.
Braiteh F et al. Characteristics, findings, and outcomes of palliative care inpatient consultations at a comprehensive cancer centerJ Palliat Med200710948-955. 15. Braiteh F, et al.: Characteristics, findings, and outcomes of palliative care inpatient consultations at a comprehensive cancer center. J Palliat Med 2007;10:948–955.
16.
Ciemins EL et al. The economic and clinical impact of an inpatient palliative care consultation service: A multifaceted approachJ Palliat Med2007101347-1355. 16. Ciemins EL, et al.: The economic and clinical impact of an inpatient palliative care consultation service: A multifaceted approach. J Palliat Med 2007;10:1347–1355.
17.
Dhillon N et al. Clinical findings of a palliative care consultation team at a comprehensive cancer centerJ Palliat Med200811191-197. 17. Dhillon N, et al.: Clinical findings of a palliative care consultation team at a comprehensive cancer center. J Palliat Med 2008;11:191–197.
18.
Osta BE et al. Interval between first palliative care consult and death in patients diagnosed with advanced cancer at a comprehensive cancer centerJ Palliat Med20081151-57. 18. Osta BE, et al.: Interval between first palliative care consult and death in patients diagnosed with advanced cancer at a comprehensive cancer center. J Palliat Med 2008;11:51–57.
19.
Ferris FD et al. Palliative cancer care a decade later: Accomplishments, the need, next steps—from the American Society of Clinical OncologyJ Clin Oncol2009. 19. Ferris FD, et al.: Palliative cancer care a decade later: Accomplishments, the need, next steps—from the American Society of Clinical Oncology. J Clin Oncol 2009.
20.
Grant M et al. Current status of palliative care–clinical implementation, education, and researchCA Cancer J Clin200959327-335. 20. Grant M, et al.: Current status of palliative care–clinical implementation, education, and research. CA Cancer J Clin 2009;59:327–335.
21.
Wright AA et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustmentJAMA20083001665-1673. 21. Wright AA, et al.: Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 2008;300:1665–1673.
22.
Periyakoil VSVon Gunten CF. Mainstreaming palliative careJ Palliat Med20071040-42. 22. Periyakoil VS, Von Gunten CF: Mainstreaming palliative care. J Palliat Med 2007;10:40–42.
23.
von Gunten CF. Palliative Medicine. ImpactJ Palliat Med200811536-537. 23. von Gunten CF: Palliative Medicine. Impact. J Palliat Med 2008;11:536–537.
24.
Schapira L et al. Phase I versus palliative care: Striking the right balanceJ Clin Oncol200927307-308. 24. Schapira L, et al.: Phase I versus palliative care: Striking the right balance. J Clin Oncol 2009;27:307–308.
25.
Bakitas M et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trialJAMA2009302741-749. 25. Bakitas M, et al.: Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. JAMA 2009;302:741–749.
26.
Higginson IJ. End-of-life care: Lessons from other nationsJ Palliat Med20058Suppl 1S161-S173. 26. Higginson IJ: End-of-life care: Lessons from other nations. J Palliat Med 2005;8 Suppl 1:S161–S173.
27.
Elsayem A et al. Impact of a palliative care service on in-hospital mortality in a comprehensive cancer centerJ Palliat Med20069894-902. 27. Elsayem A, et al.: Impact of a palliative care service on in-hospital mortality in a comprehensive cancer center. J Palliat Med 2006;9:894–902.
28.
Fadul N et al. Predictors of access to palliative care services among patients who died at a Comprehensive Cancer CenterJ Palliat Med2007101146-1152. 28. Fadul N, et al.: Predictors of access to palliative care services among patients who died at a Comprehensive Cancer Center. J Palliat Med 2007;10:1146–1152.
29.
Twycross RG. The challenge of palliative careInt J Clin Oncol20027271-278. 29. Twycross RG: The challenge of palliative care. Int J Clin Oncol 2002;7:271–278.
30.
Voltz R. [Symptomatology or Palliative Medicine?]Palliativmedizin20099197-198. 30. Voltz R: [Symptomatology or Palliative Medicine?]. Palliativmedizin 2009;9:197–198.
31.
Bruera EPeriyakoil VS. On third base but not home yetJ Palliat Med200811565-569. 31. Bruera E, Periyakoil VS: On third base but not home yet. J Palliat Med 2008;11:565–569.
32.
Bruera E. The development of a palliative care cultureJ Palliat Care200420316-319. 32. Bruera E: The development of a palliative care culture. J Palliat Care 2004;20:316–319.
33.
Yedidia MJ. Transforming doctor-patient relationships to promote patient-centered care: Lessons from palliative careJ Pain Symptom manage20073340-57. 33. Yedidia MJ: Transforming doctor-patient relationships to promote patient-centered care: Lessons from palliative care. J Pain Symptom manage 2007;33:40–57.
34.
Jemal A et al. Cancer statistics, 2003CA Cancer J Clin2003535-26. 34. Jemal A, et al.: Cancer statistics, 2003. CA Cancer J Clin 2003;53:5–26.
35.
von Gunten CF. Who uses palliative care?J Palliat Med200912209. 35. von Gunten CF: Who uses palliative care? J Palliat Med 2009;12:209.
36.
Fadul N et al. Supportive versus palliative care: What's in a name?: A survey of medical oncologists and midlevel providers at a comprehensive cancer centerCancer20091152013-2021. 36. Fadul N, et al.: Supportive versus palliative care: What's in a name?: A survey of medical oncologists and midlevel providers at a comprehensive cancer center. Cancer 2009;115:2013–2021.
37.
Von Roenn JHvon Gunten CF. Are we putting the cart before the horse?Arch Intern Med2009169429. 37. Von Roenn JH, von Gunten CF: Are we putting the cart before the horse? Arch Intern Med 2009;169:429.
38.
Levy MH et al. NCCN clinical practice guidelines in oncology: Palliative careJ Natl Compr Cancer Netw20097436-473. 38. Levy MH, et al.: NCCN clinical practice guidelines in oncology: Palliative care. J Natl Compr Cancer Netw 2009;7:436–473.
39.
McNeil C. Can guidelines be integrated into everyday practice? The NCCN in year 4. National Comprehensive Cancer Network [news]J Natl Cancer Inst199991753-755. 39. McNeil C: Can guidelines be integrated into everyday practice? The NCCN in year 4. National Comprehensive Cancer Network [news]. J Natl Cancer Inst 1999;91:753–755.

Information & Authors

Information

Published In

cover image Journal of Palliative Medicine
Journal of Palliative Medicine
Volume 13Issue Number 6June 2010
Pages: 727 - 732
PubMed: 20597705

History

Published online: 2 July 2010
Published in print: June 2010
Accepted: 25 January 2010

Permissions

Request permissions for this article.

Topics

Authors

Affiliations

Jan Gaertner
Department of Palliative Medicine, University Hospital, Cologne, Germany.
Center for Integrated Oncology, University Hospital, Cologne, Germany.
Clinical Trials Center Cologne, Köln, Germany.
Juergen Wolf
Department of Internal Medicine, University Hospital, Cologne, Germany.
Center for Integrated Oncology, University Hospital, Cologne, Germany.
Dennis Scheicht
Department of Palliative Medicine, University Hospital, Cologne, Germany.
Sebastian Frechen
Department of Palliative Medicine, University Hospital, Cologne, Germany.
Ursula Klein
Department of Palliative Medicine, University Hospital, Cologne, Germany.
Martin Hellmich
Center for Integrated Oncology, University Hospital, Cologne, Germany.
Institute of Medical Statistics, Informatics and Epidemiology, University Hospital, Cologne, Germany.
Christoph Ostgathe
Department of Palliative Medicine, University of Erlangen, Erlangen, Germany.
Michael Hallek
Department of Internal Medicine, University Hospital, Cologne, Germany.
Center for Integrated Oncology, University Hospital, Cologne, Germany.
Raymond Voltz
Department of Palliative Medicine, University Hospital, Cologne, Germany.
Center for Integrated Oncology, University Hospital, Cologne, Germany.
Clinical Trials Center Cologne, Köln, Germany.

Notes

Address correspondence to:Jan Gaertner, M.D.Department of Palliative MedicineUniversity Hospital of CologneKerpener Strasse 62Cologne 50924Germany
E-mail: [email protected]

Author Disclosure Statement

No competing financial interests exist.

Metrics & Citations

Metrics

Citations

Export citation

Select the format you want to export the citations of this publication.

View Options

Get Access

Access content

To read the fulltext, please use one of the options below to sign in or purchase access.

Society Access

If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options

PDF/EPUB

View PDF/ePub

Full Text

View Full Text

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media

Back to Top