Oncology and palliative care need greater integration
The European Society for Medical Oncology (ESMO) has awarded its Designated Centre of Integrated Oncology and Palliative Care accreditation to 16 new oncology centres. These centres received the acknowledgment at the ESMO 2012 Congress held in Vienna, Austria from 28 September to 2 October. The congress also highlighted two new Italian studies demonstrating how palliative care works in practice in Italy. The first study explores the use of analgesics; the second looks at different models for organisation of the integration of palliative care with oncology.
ESMO is committed to advancing the specialty of medical oncology and promoting a multidisciplinary approach to cancer treatment and care. Since its founding in 1975 as a non-profit organisation, ESMO’s mission has been to advance cancer care and cure. The 16 new oncology centres acknowledged at this year's congress will now entitle them to use the title 'ESMO Designated Centre of Integrated Oncology and Palliative Care' and also makes them eligible to receive fellows in palliative medicine, supported by ESMO grants.
'This year's awardees —13 based in Europe, one in Egypt, one in Singapore and one in India — demonstrate the truly international scope of ESMO's work. It shows how ESMO wants to help humanity, not just European oncology patients,' says Raphael Catane, one of the founding members of the ESMO Palliative Care Working Group.
The award, judged anonymously by ESMO Palliative Care Working Group members, assesses centres according to 13 rigorous criteria. Any oncology department or cancer centre can apply, with ESMO emphasising that size is not important, and that what matters most is the quality and extent of integration of services.
The criteria have evolved into something greater and have come to be regarded as a 'roadmap' for how to build palliative care services. Unsuccessful applicants are invited to further develop their programmes and reapply. 'What's really valuable is that we give feedback which works as a teaching tool, showing centres how they can improve,' says Dr Catane from the Institute of Oncology, Sheba Medical Center, Israel.
'In addition to making efforts to prolong the life of oncology patients, ESMO felt we needed to ensure that quality of life was good. We've made considerable efforts to change the mindset of doctors and patients that taking care of symptoms need not diminish efforts to prolong life. From the outset of diagnosis we wanted to integrate palliative care into the practice of medical oncology,' says Dr Catane.
For successful applicants, however, there is no room for complacency, as the award needs to be renewed every three years. Of the current 127 (including the 16 new centres) accredited centres, 50 have been reaccredited once (27 this year) and 21 twice (8 this year). 'With personnel, policy and financial aspects changing all the time, we want to ensure that integration of palliative care continues,' says Dr Catane.
Dr Matti Aapro, a member of the ESMO Supportive and Palliative Care Faculty, added, 'The programme is laid out in a very "user-friendly" manner which allows many centres to continue to improve their skills while already recognised as a "designated centre".'
It is worth noting that the accolade has contributed to increasing the profile of palliative care within oncology units across the world. 'ESMO's initiative has certainly raised a lot of interest, as demonstrated by the growing list of centres that adhere to this programme. It's one of many ways to encourage the development of truly multidisciplinary cancer centres which look at the patient's needs in all aspects of cancer treatment,' says Dr Aapro, from the Clinique de Genolier, Switzerland.
'While further penetration of ESMO's palliative care policy is still needed, the work of the ESMO Palliative Care Working Group has undoubtedly enhanced the lives of thousands of cancer patients in Europe and beyond,' noted Dr Catane.
Two Italian abstracts presented at the ESMO 2012 Congress demonstrate the emphasis that Italian oncologists place on monitoring palliative care in a bid to further improve services delivered to patients. As a country, Italy has a strong tradition of palliative care, as indicated with 26 centres now awarded the ESMO Designated Centre of Integrated Oncology and Palliative Care status.
The first study focused on underuse of adjuvant analgesics, and evaluated the management of pain in eight Italian oncology centres. The study also emphasises the importance of close patient follow-up.
'We set out to provide a snapshot of the management of cancer pain across Italy to see how we're doing,' says Dr Sandro Barni, the principal investigator from Treviglio Hospital, Italy. 'Our data suggest not enough cancer patients receive adjuvants. We have the impression that this is especially the case where therapies are not prescribed by oncologists. We'd like both doctors and patients to be better informed about the benefits of these drugs,' says Dr Barni.
Adjuvant analgesics (which include antidepressants, corticosteroids and bisphosphonates), are defined as drugs with a primary indication other than pain that have analgesic properties in some conditions.
The study, he adds, shows that clinicians frequently change and adjust pain treatments at follow-up visits. 'The adjustments demonstrate that you need to follow patients very carefully. Healthcare professionals should be getting cancer patients to assess pain on visual scales every time they see them, and adjusting treatments accordingly,' concludes Dr Barni.
In the second abstract, Dr Vittorina Zagonel and colleagues from the Task Force 'Continuity of Care in Oncology' of the Italian Association of Medical Oncology (AIOM), set out to evaluate integration models for oncology and palliative care in the 20 Italian ESMO designated centres that were recognised at the time of the study.
'The intention was to reveal a picture of the different types of integration models operating in ESMO designated centres. We hope to inspire the Italian oncology units who have yet to be designated to consider applications,' says Dr Vittorio Franciosi, one of the investigators from the University Hospital of Parma, who is also secretary of the Task Force. Their results show that the integrated care model operated in 75 % of centres. This is the model where the oncologist focuses on the management of the cancer and a supportive care team addresses the vast majority of physical and psychosocial concerns.