Integrating palliative care into oncology – improving the palliative care of cancer patients in the care pathway


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Tiina Saarto1
1Helsinki University and Helsinki University Central Hospital, Helsinki, Finland

Abstract

Cancer care is based on multidisciplinary teamwork with medical oncologists, radiotherapists, surgeons, pathologists, radiologists, but recently also with palliative care specialists. The palliative needs of cancer patients are various: prevention and treatment of treatment-related toxicity; rehabilitation; nutritional support; symptom control; psychosocial and spiritual counselling; and finally, end of life care. As stated by the World Health Organisation (WHO), palliative care should be introduced in oncology early in the course of illness in conjunction with anticancer therapies that are intended to prolong life to better understand and manage distressing clinical complications and symptoms. Palliative care will enhance quality of life, helping patients live as actively as possible until death and helping the family cope during the patient's illness and in their own bereavement. It may also positively influence the course of illness.

How can we manage the integration? Palliative care specialists should be responsible for advanced palliative care, but every oncologist should have basic skills. In the Cancer Center of Helsinki University Hospital, registrars specialising in oncology have three months' mandatory training in the palliative care unit, which has proved very helpful and well-liked. Consequently 13% (7/53) of oncologists working in the Cancer Center have complete special competence for palliative medicine and more are in training. On the other hand, to be able to participate in the multidisciplinary team, palliative care specialists working in cancer centers should have good knowledge of cancer care. In the Nordic countries, palliative care is not a speciality but a special competence. In the Helsinki University Hospital, palliative care specialists have different background specialties, e.g. oncology, geriatrics and psychiatry, which broaden the understanding of cancer patients needs. The collaboration between oncologists and palliative care specialists has improved, as has the common understanding for palliative care needs of the patients throughout the illness.