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1a RIUNIONE NICSO ROMA 12 MAGGIO 2014

1a RIUNIONE NICSO ROMA 12 MAGGIO 2014. Supportive cancer care – the fundamentals SUPPORTIVE AND PALLIATIVE CARE COMPLEMENTARY IN CANCER MANAGEMENT MATTI S. AAPRO GENOLIER, SWITZERLAND. 1a RIUNIONE NICSO ROMA 12 MAGGIO 2014. Supportive cancer care – the fundamentals

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1a RIUNIONE NICSO ROMA 12 MAGGIO 2014

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  1. 1a RIUNIONE NICSOROMA 12 MAGGIO 2014 Supportive cancer care – the fundamentals SUPPORTIVE AND PALLIATIVE CARE COMPLEMENTARY IN CANCER MANAGEMENT MATTI S. AAPRO GENOLIER, SWITZERLAND

  2. 1a RIUNIONE NICSOROMA 12 MAGGIO 2014 Supportive cancer care – the fundamentals SUPPORTIVE AND PALLIATIVE CARE COMPLEMENTARY IN CANCER MANAGEMENT MATTI S. AAPRO GENOLIER, SWITZERLAND

  3. Distinction between supportive care and palliative care What are the objectives of supportive care? What does supportive care mean to the clinician, nurse, patient, and caregivers? Effective strategies to overcome the challenges and improve patient outcomes Ethical considerations

  4. Disclosures CLINIQUE DE GENOLIER Collaborations in this field: Teva, Sanofi, Sandoz, Roche, Novartis, Merck, Johnson & Johnson, Hospira, Helsinn, Amgen

  5. Percentage of total population aged 60 years or older 2050 Percentage aged60 years or older in 2050: 0–9 10–19 20–24 No data United Nations. Population Division. Department of Economic and Social Affairs. Population Ageing. 2050

  6. Distinction between supportive care and palliative care What are the objectives of supportive care? What does supportive care mean to the clinician, nurse, patient, and caregivers? Effective strategies to overcome the challenges and improve patient outcomes Ethical considerations

  7. SUPPORTIVE AND PALLIATIVE CARE

  8. SUPPORTIVE AND PALLIATIVE CARE • Whatis the differencebetweenthesetwo aspects of patient care? • Where does "palliation" end or "support" start?

  9. SUPPORTIVE AND PALLIATIVE CARE • One has to realizethatthereisa continuum in support and palliation. • Today's management of patients with cancer is of a multidisciplinary nature, a factexemplified by the bi-annualEuropeanMultidisciplinary Cancer Care Conference.

  10. MASCC Concept of Supportive Care SUPPORTIVE CARE PALLIATIVE CARE TEAM CANCER THERAPY CURE PROLONG/PALLIATE DIAGNOSIS DEATH RECURRENCE D. Warr

  11. SUPPORTIVE AND PALLIATIVE CARE Historical reasons have led to the development of specialist groups with expertise towards issues • frequent at the end of life (often called palliative care) • around treatment management, and post-treatment issues (supportive care)

  12. Distinction between supportive care and palliative care What are the objectives of supportive care? What does supportive care mean to the clinician, nurse, patient, and caregivers? Effective strategies to overcome the challenges and improve patient outcomes Ethical considerations

  13. SUPPORTIVE AND PALLIATIVE CAREMultinational Association for Supportive Care in Cancer (MASCC) Supportive care is the prevention and management of the adverse effects of cancer and its treatment. This includes management of physical and psychological symptoms and side effects across the continuum of the cancer experience from diagnosis through anticancer treatment to post-treatment care. MASCC. www.mascc.org,

  14. SUPPORTIVE AND PALLIATIVE CAREMultinational Association for Supportive Care in Cancer (MASCC)   Enhancing rehabilitation, secondary cancer prevention, survivorship and end of life care are integral to supportive care. MASCC. www.mascc.org,

  15. SUPPORTIVE AND PALLIATIVE CAREMultinational Association for Supportive Care in Cancer (MASCC) Supportive care alleviates symptoms and complications of cancer, reduces or prevents toxicities of treatment, supports communication with patients about their disease and prognosis, allows patients to tolerate and benefit from active therapy more easily, eases emotional burden of patients and caregivers, helps cancer survivors with psychological and social problems. MASCC. www.mascc.org,

  16. Effects Of Bisphosphonate Treatment On Recurrence And Cause-specific Mortality In Women With Early Breast Cancer: A Meta-analysis Of Individual Patient Data From Randomised Trials R Coleman, M Gnant, A Paterson, T Powles, G von Minckwitz, K Pritchard, J Bergh, J Bliss, J Gralow, S Anderson, D Cameron, V Evans, H Pan, R Bradley, C Davies, R Gray. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG)’s Bisphosphonate Working Group.

  17. Mortality In Post-menopausal Women Breast cancer mortality All cause mortality 1524 events 1146 events

  18. Distinction between supportive care and palliative care What are the objectives of supportive care? What does supportive care mean to the clinician, nurse, patient, and caregivers? Effective strategies to overcome the challenges and improve patient outcomes Ethical considerations

  19. CINV ControlPROGRESS SINCE the 80’s Cisplatin (HEC) Protocole “AC” CINV complete control Over 5 days 75% 85% 50% 60% 50% 50% 10% 0% 1978 1988 1998 2008 HD-MCP + Dex Setron + Dex Setron+ Dex + NK1RA HD-MCP= Hi dose Metoclopramide haute dose Dex = Dexamethasone Jordan K and Feyer P, 2012 CINV Chemo induced Nausea and Vomiting

  20. SUPPORTIVE AND PALLIATIVE CARE There is recent interest in palliative care as a means to support patients and have an impact on survival A study of patients with advanced non small-cell lung cancer, has reported that early palliative care improves quality of life, mood, and survival despite less aggressive end-of-life care compared with standard oncology care alone Temel JS, Greer JA, Muzikansky A, et al: Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363:733-742.

  21. « Early Palliative Care » Survie Globale • Standard Care • Early Palliative Care Temel J et al. NEJM 2010

  22. PALLIATIVE CAREAN ASCO POSITION ASCO panel’s 2012 expert consensus indicates that combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden. Smith TJ, Temin S, Alesi ER et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J ClinOncol. 2012; 30: 880-887.

  23. SUPPORTIVE AND PALLIATIVE CAREESMO’s POSITION ESMO had stated in 2003 already that “Since most cancer patients receive their cancer care in dedicated clinics or hospitals », it is imperative that these facilities provide an adequate supportive and palliative care infrastructure as part of the global service. Cherny NI, Catane R, Kosmidis P. ESMO takes a stand on supportive and palliative care. Ann Oncol 2003; 14: 1335-1337.

  24. Distinction between supportive care and palliative care What are the objectives of supportive care? What does supportive care mean to the clinician, nurse, patient, and caregivers? Effective strategies to overcome the challenges and improve patient outcomes Ethical considerations

  25. SUPPORTIVE AND PALLIATIVE CAREThe European Society for Medical Oncology (ESMO) ESMO has recognized the importance of patient centered care for a long time, and one of its key programmes is its Designated Centers of Integrated Oncology and Palliative Care. ESMO. http://www.esmo.org/education-research/designated-centers-of-integrated-oncology-and-palliative-care.html

  26. SUPPORTIVE AND PALLIATIVE CAREESMO Designated Centers of Integrated Oncology and Palliative Care Any oncology department or cancer center can apply: Size is not important; to be eligible what matters are the quality and the extent of the integration of services. The criteria for accreditation are based on recommendations from the World Health Organization (WHO) guidelines on the provision of palliative care for patients with cancer, and reflect the issues of integration, credentialing, service provision, research and education.

  27. SUPPORTIVE AND PALLIATIVE CARE None of the above comments detracts from the importance of centers of excellence in palliative care, named hospices in many cultures

  28. Distinction between supportive care and palliative care What are the objectives of supportive care? What does supportive care mean to the clinician, nurse, patient, and caregivers? Effective strategies to overcome the challenges and improve patient outcomes Ethical considerations

  29. Take Home Message • “Supportive care makes excellent cancer care possible” • Dorothy M.K. Keefe, MASCC president

  30. THE EUROPEAN SCHOOL OF ONCOLOGY Alberto Costa,MD Scientific Director www.eso.net

  31. CancerWorld Magazine2012

  32. PREDICTING SURVIVAL[ECC 2013, Abs 1745]. Rotteveel K et al. Abstract 1745 ESMO 2013.

  33. FOUR GROUPS MEDIAN SURVIVAL (MS) AND MORTALITY (M)AT 90 DAYS (D90) • - Score ≥ 4: MS 2,6 ms D90 M 79%, • - Score = 3: MS 5,0 ms D90 M 43%, • - Score = 2: MS 7,1 ms D90 M 31%, • - Score = 1: MS 9,5 ms D90 M 28%, • - Score = 0: MS 15 ms D90 M 17%. Rotteveel K et al. Abstract 1745 ESMO 2013.

  34. and …..please access this article via the ESO website

  35. YES, A CONCLUSION IS NEEDED

  36. SUPPORTIVE CARE IN CANCER 27th International Symposium MASCC/ISOO AVEC SÉANCE AFSOS June 2014 MIAMI U.S.A. www.mascc.org

  37. PARIS 15 – 17 Octobre 2014 Espace Cardin Paris

  38. 21-22-23 Novembre 2013HEGP Auditorium Paris 20 – 22 November 2014 Georges Pompidou European Hospital Paris, France

  39. AND ONE MORE USEFUL WEBSITE • http://qualityoflife.elsevierresource.com/

  40. AND OF COURSE PLEASE COME TO THE • NEXT • NICSO MEETING!

  41. NICSO 2014 CONCLUSION SUPPORTIVE AND PALLIATIVE CARE ARE COMPLEMENTARY AND ESSENTIAL IN CANCER PATIENT TREATMENT MATTI S. AAPRO GENOLIER, SWITZERLAND

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