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Ospital ng Maynila Medical Center

Hospital Tumor Board

 

Statements on Certain Cancer Issues

February 20, 2003

 

Objective:

To promote a unified and consensual concept on cancer issues among OMMC staff that will be used as a guide in management of patients with cancer in OMMC and that will serve as OMMC’s public health information and education on cancer.

 

Cancer Palliative Management

 

What is a curative cancer treatment?

 

Curative cancer treatment is one that is done with intent to cure as contrasted to palliative cancer treatment, one that is done with just the intent to palliate, realizing and accepting that cure is practically impossible.

 

A realistic intent to cure is present or should be instituted if there is a known treatment regimen (single or combined modality) that will achieve complete response of all evident cancers.  If not, then the realistic objective of treatment is just to palliate.

 

Likewise, a realistic intent to cure is present or should be instituted for cancers in their early stage.  For cancers in the advanced stage, the realistic objective of treatment is just to palliate.

 

What is a palliative cancer treatment?

 .

Palliative cancer treatment is a treatment regimen that relieves symptoms, such as pain, but is not expected to cure the cancer. The main purpose is to improve the patient's quality of life.

 

Palliative treatment is done for patients with cancers, usually those in the advanced stage, with statistically very little chance for cure.

 

What is hospice care?

 

Based on the World Health Organization’s definition, the following are the concept of hospice care:

 

“The active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families.”

 

“…affirms life and regards dying as a normal process, …neither hastens nor postpones death,…provides relief from pain and other distressing symptoms,…offers a support system to help the family cope during the patient’s illness and in their own bereavement.”

 

 

Hospice care is the concept of management of patients whose disease is and will not be responsive to curative treatment.

 

It does not refer to the place where hospice care is rendered.  The care can be rendered anywhere, in the hospital, centers devoted to care of such patients,  physicians’ clinics, or at home. 

 

The concept of hospice care is applicable in both cancer and non-cancer patients.   The common starting point of hospice care in these patients is the presence of a disease not responsive to curative treatment.

 

What is the difference between palliative and hospice care?

           

If there is a difference between palliative and hospice care in how they are presently being used, the concept of palliative care is confined to the patient whereas that of hospice care extends to the family of the patient … “ offers a support system to help the family cope during the patient’s illness and in their own bereavement.” (WHO Definition)

 

What are two categories (in terms of average survival time) of cancer patients whose cancer is or will not be responsive to curative treatment that can be used as a guide in palliative management?

 

Terminally-ill cancer patients – patients in which death is expected in a relatively short period of time (within one year).

 

Not-yet-terminally-ill cancer patients – patients in which death is not expected in a relatively short period of time (within one year).

 

There are different forms, kinds, and types of palliative care for cancer patients.  What should be the essential guiding principles in decision-making in terms of objective, selection and administration of palliative care?

 

Administer palliative care to improve and maintain as much as possible an acceptable quality of life and control of symptoms up to the last moment of the patient’s stay on earth.

 

Select type of care based on benefit-risk-cost-availability analysis of different treatment options.

 

Administer palliative care with informed consent.

 

 

What are the different forms, kinds, or types of palliative care in cancer?

 

Objectives

Relief of

Surgery

Radiation

ChemoTx

Analgesics

PsychoTx

Others

Pain

 

 

 

 

 

 

Obstruction

 

 

 

 

 

 

Dyspnea

 

 

 

 

 

 

Foul-smelling cancer wounds

 

 

 

 

 

 

Other symptoms

 

 

 

 

 

 

 

 

How aggressive should palliative treatment be?

 

The guiding principles consist of the following:

 

Administer palliative care to improve and maintain as much as possible an acceptable quality of life and control of symptoms up to the last moment of the patient’s stay on earth.

 

Select type of care based on benefit-risk-cost-availability analysis of different treatment options.

 

Administer palliative care with informed consent.

 

Administer aggressive palliative treatment to patients with a high chance of cancer control.   “Aggressive” palliative treatment here means instituting treatment modalities that will control the cancer.

 

When is an advice of “no aggressive palliative treatment “ given?

 

When chances of control of cancer are very low.  Palliative treatment will be done just for control of symptoms and not for control of the cancer anymore.

 

When is an advice of “do not resuscitate” given to a terminally-ill cancer patient?

 

When the probability of the terminally-ill cancer patient going into a cardiopulmonary arrest as a consequence of the cancer is high.

 

When the terminally-ill cancer patient is already in the vegetative state.

 

When the burden of treatment outweighs the benefit.

 

When the terminally-ill cancer patient and/or guardian expresses and signs a “do not resuscitate” order. 

 

Give examples of application of aggressive, no aggressive, and do not resuscitate advices:

 

Conditions

Aggressive

No aggressive

Do not resuscitate

Stage IV breast cancer with dyspnea secondary to massive pulmonary metastases

x

Relief of dyspnea

No more cancer control treatment modality

DNR  once moribund

Stage IV breast cancer with bone metastasis

Host performance status - 1

Control of cancer

 

 

Thyroid follicular carcinoma with bone metastasis

x