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Dr Esther Cege Munyoro Palliative Care Unit KNH Palliative care: CURRENT TRENDS AND INNOVATIONS IN MANAGEMENT OF CANCER.

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Presentation on theme: "Dr Esther Cege Munyoro Palliative Care Unit KNH Palliative care: CURRENT TRENDS AND INNOVATIONS IN MANAGEMENT OF CANCER."— Presentation transcript:

1 Dr Esther Cege Munyoro Palliative Care Unit KNH Palliative care: CURRENT TRENDS AND INNOVATIONS IN MANAGEMENT OF CANCER

2 Palliative Care The current WHO Definition states: “Palliative Care is an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering, the early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” (WHO 2002)

3 ...….an inverse relationship between the expectation of an individual and the actual situation in which they find themselves. The smaller the gap between the two, the better the quality of life. Calman(1984)

4 The Calman gap: quality of life deficit 4 TIME Reality Hopes and Aspirations GAP Increasing quality of life CONSULTATION TIME Modified expectation Improved circumstances

5 Measurement QOL; Four Core Domains Physical  Pain,mobility, sleep  Appetite and nausea  Sexual functioning. Psychological  Depression  Anxiety  Adjustment to disease Occupational  Ability and desire to carry out paid employment.  Ability to cope with household duties. Social  Personal and sexual relationships.  Engagement social and leisure activities.

6 Conceptual Shift for Palliative Care Hospice Hospice Life Prolonging Care Palliative Care Bereavement Hospice Care Life Prolonging Care New Old Death illness

7 PAIN AND SYMPTOM MANAGEMENT 7 Quality of Life for the Terminally Ill Cancer Patients in Kenya; An assessment of the Deficit and Need for Palliative Care. The Diana, Princess of Wales Memorial Fund Research Project in October 2008 Lead Researcher: Dr. Zipporah Ali Co-Researchers: Dr. Esther Munyoro & Dr. Robai Gakunga

8 8 242 adult patients with terminal cancer from 4 referral hospitals across Kenya were assessed for pain and other symptoms on a 0 (no pain) to 10 (worst pain) scale. NYERI KISUMU MOMBASA NAIROBI

9 9 Prevalence of Patients Reporting Severe Symptoms (Mombasa)

10 COMMUNICATION Employs communication skills with patients, families and professional colleagues Research shows healthcare workers have poor communication skills Communication skills can be taught

11 Communication Research shows that communication is an art that one can learn and it gets better with practice. Interactive communication requires five key elements  open-ended questions;  awareness of nonverbal cues  active listening  reflective responses; and  verification of understanding. Studies show that most people are not good listeners.

12 TEAMWORK and Communication All members contribute as necessary so that the patient has a management plan regardless of the point of care. Palliative care helps reduce hospital length of stay by coordinating care for patients with high levels of need who should be moved to the next point of care. Documentation and discharge planning are important. Organized patient held records should become part of our healthcare system to allow reduced costs, higher standard care and continuity of care between different care setting.

13 Complex decision making and Goal setting

14 Information sharing, when to share,how much and need to sustain hope. When making decisions about treatment which has uncertain outcome the different values that the patient, healthcare worker and family have, financial implication etc will all come into play. The right to life how far should we go to keep life going and at what expense to quality of life. This becomes very difficult especially when dealing with children where emotional issues are raised.

15 Evolution; Change and Challenges Currently development of non curative but potentially beneficial interventions to address so many of the conditions, symptoms and complications confronted by patients has created new opportunities, new tensions and new dilemmas for clinicians.

16 New palliative interventions exist Endoscopic interventions and interventional radiology has broadened the range of options in the cases of obstruction of luminal structures. This has altered management of intestinal, biliary, ureteric, and bronchial obstruction, venous compression syndromes and in select cases pain management.  Stents  Percutaneous endoscopic gastrotomy  Drains for pleural effusions

17 A stent placed inside the urinary system Stents are effective tools for the endobronchial management of lung cancer. Endobronchial Prostheses P.E.G Feeding tube

18 SURGICAL APPROACHES Major changes to management of complications of cancer such as spinal cord compression, brain metastases and impending fractures. Various catheter systems provides effective at-home palliation of symptoms associated with recurrent pleural effusions and malignant ascites.

19 Promoting the concept of palliative care may contribute to overcoming the curative model in medicine in situations where it is more appropriate to accept the chronic nature of the disease and to offer best medical and supportive palliative care. This has implication for planning and finances as more money needs to be allocated to supportive services.

20 Palliative Care Extends Life, Study Finds 3-year study, 151 pts with fast-growing lung cancer at Massachusetts General, top hospital, were randomly assigned to get either oncology treatment alone or oncology treatment with palliative care — pain relief and other measures intended to improve a patient’s quality of life. Followed until the end of 2009, by which time about 70 percent were dead. Temel, et al 2011 Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer The new England journal o f medicine 363;8 nejm.org august 19, 2010

21 FINDINGS Those getting palliative care from the start  reported less depression and happier lives as measured on scales for pain, nausea, mobility, worry and other problems.  Moreover, even though substantially fewer of them opted for aggressive chemotherapy as their illnesses worsened and  many more left orders that they not be resuscitated in a crisis,  they typically lived almost three months longer than the group getting standard care, who lived a median of nine months. Temel, et al 2011 Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer The new England journal o f medicine 363;8 nejm.org august 19, 2010

22 Major areas of need that have shown improvement as a result of palliative care include Pain and symptom management Patient and family satisfaction Nurse retention and satisfaction Bed and ICU capacity Length of stay Pharmacy costs Establishment and strengthening of hospice partnerships Fragmented subspecialty care is possible Time demands on physicians for complex communications and decision making

23 “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to walk through water without getting wet.” Rachel Naomi Remen.

24 24 THANK YOU


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