Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
care with serious illness and the focus of Palliative Care is on providing relief
from symptom and improving the quality of life of patients. Palliative Care is
not End-of-Life or hospice but encompasses both. There is a dichotomy in the
principle of medical care in cancer which single mindedly focuses on attempts
to cure every patient at every stage. Recognition of the importance of
symptom control and other aspects of Palliative care from diagnosis through
dying process has been growing. Patients should not have to choose between
treatment with curative intent or comfort care. There is need for both in
varying degrees throughout the course of cancer whether the eventual
outcome is survival or death. The goal is to maintain the best possible quality
of life allowing the patients to choose whatever treatment they so wish while
also meeting the needs of advanced disease through adequate symptom
control. This goal is most often not met. For atleast half of those patients
dying from cancer - most of whom are elderly and many vulnerable - death
entails a spectrum of symptoms including pain, labored breathing, distress,
nausea, confusion, and other physical and psychological conditions that go
untreated and vastly diminishes the quality of remaining days. The patient is
not the only one who suffers; family, care givers undergo unreleaved emotion
and financial burden. This cannot be ignored within the context of the
patients’ who are terminally ill. A major problem in Palliative care is the under
recognization, under diagnosis and thus undertreatment of the patients with
significant stress ranging from existentional anguish, axiety and depression.
Living with and eventually dying from a chronic illness runs substantial cost
for patients, family, society and cost of those dying from cancer are 20%
higher than average costs. Inadequacy of Palliative and End-of-Life care
springs not from a single cause of a sector of society the separation of
palliative and hospice care from potentially life prolonging treatment within
the health care system, which is both influenced by and affects
reimbursement policy; inadequate training of health care personnel in
symptom management and other palliative care skills; inadequate standards
of care and lack of accountability in caring for dying patients; disparities in
care, even when available, for ethnic and socioeconomic segments of the
population; lack of information resources for the public dealing with palliative
and end-of-life care; lack of reliable data on the quality of life and the quality
of care of patients dying from cancer (as well as other chronic diseases); and
low level of public sector investment in palliative and end-of-life care research
and training. This is not to suggest that there is no relevant ongoing research
or relevant question or training program - there are - but the efforts are not
coordinated and there is no focus for these activities in the Government
agencies. What has resulted is under funding, lack of training and lack of
research, leadership, with no sustained program for developing and
disseminating Palliative treatment. Care for those approaching death is an
integral and important part of health care. Everyone dies, and those at this
stage of life deserve attention that is as thorough, active, and conscientious
as that granted to those for whom cure or longer life is a realistic goal. Care for
those approaching death should involve and respect both patients and those
close to them. Particularly for patients with a grim prognosis, clinicians need
to consider patients in the context of their families and close relationships
and to be sensitive to their culture, values, resources, and other
characteristics. Good care at the end of life depends on strong interpersonal
skills, clinical knowledge, and technical proficiency , and it is informed by
scientific evidence, values, and personal and professional experience. Clinical
excellence is important because the frail condition of dying patients leaves
little margin to rectify errors. Changing individual behavior is difficult, but
changing an organization or a culture is potentially a greater challenge—and
often is a precondition for individual change. Deficiencies in care often reflect
flaws in how the health care system functions, which means that correcting
problems will require change at the system level. The health care community
has special responsibility for educating itself and others about the
identification, management, and discussion of the last phase of fatal medical
problems. Although health care professionals may not have a central presence
in the lives of some people who are dying, many others draw heavily on
physicians, nurses, social workers, and others for care—and caring. Thus,
health care professionals are inescapably responsible for educating
themselves and helping to educate the broader community about good care
for dying patients and their families. More and better research is needed to
increase our understanding of the clinical, cultural, organizational, and other
practices or perspectives that can improve care for those approaching death.
The knowledge base for good end-of-life care has enormous gaps and is
neglected in the design and funding of biomedical, clinical, psychosocial, and
health services research. Time is now to integrate Palliative care with
mainstream care in cancer.
Keywords: Palliative-care, Cancer-care, Improving Cancer-care, End-of-Lifecare
ED02: PALLIATIVE CARE IN LUNG CANCER: A GLOBAL CHALLENGE
MONDAY, DECEMBER 5, 2016 - 11:00-12:30
ED02.04 PALLIATIVE CARE IN SOUTH-EAST ASIA
Richard Lim
Department of Palliative Medicine, Selayang Hospital, Batu Caves/Malaysia
Southeast Asia comprises of 10 main countries including Malaysia, Indonesia,
Thailand, Philippines, Singapore, Brunei, Cambodia, Laos, Myanmar and
Vietnam. The concept of palliative care first developed around the mid-
1980s in Singapore and the Philippines and later in the 1990s in Malaysia,
Thailand and Indonesia. In other countries such as Brunei, Cambodia,
Myanmar, Vietnam and Laos palliative care has only been developing more
rapidly over the past 10 years. Levels of development of palliative care in
Southeast Asia are highly variable depending very much upon factors such
as availability of medical resources, funding, geography, demographics and
the priorities of the country’s leadership. In 2011, the Worldwide Palliative
Care Alliance(WPCA) mapped out the global development of palliative care
dividing countries into 4 categories. Category 1 where there is no known
development of palliative care, category 2 where development is at the level
of capacity building, category 3 where there is isolated provision of palliative
care services and category 4 where services are approximating integration
into mainstream medicine. Among these countries, only Singapore and
Malaysia have achieved category 4 status while majority are in category 3
(Indonesia, Thailand, Philippines, Myanmar, Cambodia, Brunei and Vietnam).
Regardless of the level of development, challenges faced in developing
palliative care in Southeast Asia are common throughout and include first
and foremost barriers of drug availability and fear of using opioids amongst
public as well medical practitioners. Apart from this is the challenge of public
perceptions towards death and dying which have made development of this
discipline difficult. Even till today there are many misconceptions regarding
the role and concept of palliative care amongst healthcare professionals. For
countries that are more advanced in their development, the key challenge
now is how to continue development in a sustainable manner and how to
improve and maintain standards of care. In Malaysia, palliative care began in
the early 1990s with the development of voluntary organisations providing
homecare services for patients with terminal cancer. In 1995 the concept was
introduced into government hospitals and soon received nationwide support
by the Ministry of Health in Malaysia. In 2005, the subspecialty of palliative
medicine was established and a formalised training programme for medical
specialists was developed. At present there are a total of 18 trained palliative
medicine specialists in Malaysia with 2 more in training. In 2014, an advanced
diploma programme for nurses, physiotherapists and occupational therapists
was developed in the Ministry of Health which has now trained 38 nurses
and paramedics who have now become permanent stakeholders in palliative
care service provision and development. Apart from this, non-governmental
organisations also serve as a backbone to community palliative care services
in Malaysia and there are currently 25 services throughout the country
providing homecare. It is with such initiatives that Malaysia hopes to create a
sustainable and credible workforce to continue the development and growth
of palliative care throughout the nation and possibly the region.
Keywords: palliative care, opioid availability, end-of-life care, advanced cancer
ED02: PALLIATIVE CARE IN LUNG CANCER: A GLOBAL CHALLENGE
MONDAY, DECEMBER 5, 2016 - 11:00-12:30
ED02.05 PALLIATIVE CARE IN IRAN
Reza Malayeri
Palliative Care Unit, Firoozgar Hospital, Tehran/Iran
It is well known that palliative care is a necessity in cancer patients, as early on
as the time of diagnosis. In adult oncology, there is evidence to suggest early
specialist palliative care improves HRQOL, mood, treatment decision-making,
health-care utilization, advanced care planning, patient satisfaction, and
end-of-life care (1). Early admission to community-based palliative care also
reduces the use of Emergency departments by cancer patients in the 90 days
before death (2). Palliative care for cancer patients is rather new in Iran and
has a history of less than 7 years. Here we give an overview on the status of
palliative care in Iran. We also present the demographics of our patients in the
first and largest palliative care ward in Iran over the last two years. Iran has a
population of around 80 million people. In Iran, cancer is known as the third
cause of death. Adult morbidity rate of cancer in different regions of Iran is
estimated 48-112 cases per million people among the females and 51-144 cases
per million people among the males (3). Also, mortality rate related to cancer
was about 53500 people in 2014 (4). The majority of cancer patients expire
in the intensive care units (ICU), whereas bed occupancy of ICUs is in crises,
being about 100% in Iran. For each ICU bed, 4 people are applicants (5). We
currently have around 8 active palliative care units for cancer patients and one
palliative care ward in Iran, all run by charities. In these palliative care units,
we have oncologists, palliative care specialists, pain specialists, psychologists,
spiritual care specialists, social workers and dieticians. A total number of 3677
patients, ages between 16 and 94 (Median 61), of whom 3277 (89%) with a
similar age distribution had a cancer diagnosis were referred to our palliative
care unit in Firoozgar Hospital, which is run by the Ala Charity, in Tehran in
the last three years. 1770 female (54%) and 1457 male (46%) advanced cancer
patients were referred. A number of 388 (12%) patients had breast cancer,
Copyright © 2016 by the International Association for the Study of Lung Cancer
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