Patients with advanced cancer are known to have lower quality of life. Their quality of life tends to worsen towards the end of life. WHO defined an approach to increase patients quality of life called palliative care.1 Palliative care is care given to improve patient’s quality of life, especially patients with serious or life-threatening disease such as cancer. This care address a number of patient’s issues including physical, emotional, coping, spiritual, caregiver needs, and practical needs. Palliative care may be provided at any point during cancer treatment from diagnosis until the end of life and may be given together with cancer treatment.2 A number of studies have shown that palliative care for cancer patients improved their quality of life.1,3-5 One study supports early integrated palliative care to improve patient’s quality of life.5
Bruera and Hui suggested three models for integration of palliative care in oncology, the models were as follow:
Solo Practice Model: In this model, the oncologist will take care all the primary disease assessment and management as well as the palliative care needs. The patient will receive all aspects of care from the same health care professional but this model may result in burnout in the oncologist as a result from the need to assume all aspects of care. Furthermore, the oncologist need to receive extensive training in palliative care to deliver high-quality care. This model is frequent in private practices and small communities.
Congress Practice Model: In this model, the primary oncologist refers the patient to multiple consultants including the palliative care specialist. Here, the palliative care is limited to addressing end-of-life issues. While this model attempted to obtain interdisciplinary care, it can be exhausting and expensive for the patient and family. The lack of interaction between specialists may also result in conflicting messages, drug interactions, and aggravation of one problem while resolving the other.
Integrated Care Model: In this model, the palliative care were conducted by a team allowing the primary oncologist to focus primarily on cancer management. The palliative care team will address the physical and psychosocial concerns of the patient. This model may reduce the number of visit and cost of treatment.6
Among the models above, which model may be the best choice to integrate palliative care with cancer treatment? Or maybe there are other model to better integrate palliative care?
1. Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383(9930):1721-1730.
2. Palliative Care in Cancer [Internet]. National Cancer Institute. 2019 [cited 28 January 2019]. Available from: https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet
3. Hui D, Kim S, Roquemore J, Dev R, Chisholm G, Bruera E. Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer. 2014;120(11):1743-1749.
4. Friedrichsdorf S, Postier A, Dreyfus J, Osenga K, Sencer S, Wolfe J. Improved Quality of Life at End of Life Related to Home-Based Palliative Care in Children with Cancer. Journal of Palliative Medicine. 2015;18(2):143-150.
5. Temel J, Greer J, El-Jawahri A, Pirl W, Park E, Jackson V et al. Effects of Early Integrated Palliative Care in Patients With Lung and GI Cancer: A Randomized Clinical Trial. Journal of Clinical Oncology. 2017;35(8):834-841.
6. Bruera E, Hui D. Integrating Supportive and Palliative Care in the Trajectory of Cancer: Establishing Goals and Models of Care. Journal of Clinical Oncology. 2010;28(25):4013-4017.