key: cord-1048179-capjmt37
authors: Power, Jenny; Gouldthorpe, Craig; Davies, Andrew
title: Palliative care in the era of novel oncological interventions: needs some “tweaking”
date: 2022-04-30
journal: Support Care Cancer
DOI: 10.1007/s00520-022-07079-2
sha: c794f894640df9a505b36162720e09c2379ceccb
doc_id: 1048179
cord_uid: capjmt37

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• Includes, prevention, early identification, comprehensive assessment, and management of physical issues, including pain and other distressing symptoms, psychological distress, spiritual distress, and social needs. Whenever possible, these interventions must be evidence based • Provides support to help patients live as fully as possible until death by facilitating effective communication, helping them, and their families determine goals of care • Is applicable throughout the course of an illness, according to the patient's needs • Is provided in conjunction with disease-modifying therapies whenever needed • May positively influence the course of illness • Intends neither to hasten nor to postpone death, affirms life, and recognizes dying as a natural process • Provides support to the family and caregivers during the patient's illness, and in their own bereavement • Is delivered recognizing and respecting the cultural values and beliefs of the patient and family • Is applicable throughout all health care settings (place of residence and institutions) and in all levels (primary to tertiary) • Can be provided by professionals with basic PC training • Requires specialist PC with a multiprofessional team for referral of complex cases In many areas, specialist palliative care services are well embedded within oncology centres, although the format / function of these services varies widely. Thus, many services focus on patients with advanced disease, whilst only some services also provide "early" palliative care, and/or supportive care (as defined by MASCC) [4] . The IAHPC definition encompasses these newer models of care. However, while the principles remain the same, the specifics need to be amended ("tweaked") depending on the specific patient population. In other words, palliative care healthcare professionals (HCPs) need to adopt a "similar but different" approach (cf. COVID-19 pandemic) [5] .

Importantly, palliative care HCPs need to appreciate the impact of novel anticancer treatments in terms of likelihood of response, type of response (e.g. partial remission, complete remission), duration of response, and potential acute and chronic toxicities. This will require specific education and training, and so a major change to many existing postgraduate curricula. Palliative care HCPs will also need to review / research the appropriateness of standard palliative care interventions in the differing patient populations. For example, opioids are a valid option in cancer patients with acute pain, and in those with pain at the end-of-life. However, opioids have a less defined role in cancer patients with chronic pain, due to lessened efficacy, and concerns about adverse events (e.g. endocrine effects, immune system effects) [6] . Furthermore, there is the universal problem of limited resources (especially human resources). If specialist palliative care services are to increase their input into patients with early cancer and "cancer survivors", then they will need to develop appropriate models of care for these patients (e.g. a needs-based, "dip in -dip out" approach). Importantly, specialist palliative care services must not spread themselves so thin that they provide inadequate care for their core group of patients (i.e. patients with advanced cancer). Indeed, despite the advances in anticancer treatment, many cancer patients still do not have "good" outcomes, and cancer remains a major cause of death worldwide.

Finally, it should be noted that many specialist palliative care services have been re-branded as supportive care services (or supportive and palliative care services), due to the negative perceptions of the term "palliative care" amongst patients and oncology healthcare professionals [7, 8] . This practice has been criticised for the rationale for alteration [9] , but more importantly because many of these palliative care services do not provide "comprehensive" supportive care services [2] . Thus, palliative care is an important component of supportive care [4] , but supportive care encompasses more than palliative care, and necessitates the input from other specialist teams / services (Fig. 1) [10] .

Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Other services Fig. 1 The "extended" supportive care team [10] .

The integration of early palliative care with oncology care: the time has come for a new tradition

Supportive care is broader than palliative care

Redefining Palliative Care -a new consensus-based definition

Multinational Association for Supportive Care in Cancer website

Palliative care in the context of a pandemic: similar but different

Opioid side effects and their treatment in patients with chronic cancer and noncancer pain

Cancer patients' perceptions of palliative care

Association between a name change from palliative to supportive care and the timing of patient referrals at a comprehensive cancer center

Should palliative care be rebranded

Supportive Care: an indispensable component of modern oncology