Living with Ovarian Cancer: How Palliative Care Can Help Elizabeth Loggers, MD, PhD Medical Director, Supportive and Palliative Care Seattle Cancer Care Alliance Associate Member Fred Hutchinson Cancer Research Center

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HAVE YOU EXPERIENCED PALLIATIVE CARE?

WHO Definition of Palliative Care Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care: provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten or postpone death; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until death; offers a support system to help the family cope during the patient’s illness and in their own bereavement; uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated; will enhance quality of life, and may also positively influence the course of illness; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. WHO Definition of Palliative Care History: The word “palliative” comes from the latin word pallium (cloak/cover). When a patient receives palliative care, the intent is to “cover-up” the pain and other debilitating symptoms so that they are reduced or completely “covered” and no longer visible. National cancer control programmes: policies and managerial guidelines, 2nd ed. Geneva, World Health Organization, 2002.

Palliative Care: Bridge Repair https://youtu.be/lDHhg76tMHc?t=43 https://youtu.be/lDHhg76tMHc https://getpalliativecare.org/palliative-care-bridge/

5 Randomized Trials including Cancer Patients No harm in any trial Better patient understanding Improved satisfaction, communication More advance directives Better symptom control and quality of life Lower costs Higher quality of EOL care Fewer readmissions, ED and ICU use; longer hospice LOS; increase in home death Better survival A systematic review suggests positive effects of palliative care teams in multiple settings and on multiple outcomes, including pain and symptom control, improved mood and reductions in hospital admissions.3 Higginson IJ, e al. Cancer J. 2010; 16(5):423-435 Parikh, N Engl J Med 369;24 December 12, 2013

Early Palliative Care for Lung Cancer Temel, et al. NEJM. 2010; 363:733-742.

Society for Gynecologic Oncology Clinical Practice Recommendations “Do not delay basic level palliative care for women with advanced or relapsed gynecologic cancer, do refer to a palliative care specialist when needed....” Rimel BJ, et al, Gynecologic Oncology 137 (2015) 280-284.

Palliative Care and Ovarian Cancer

Palliative Care and Ovarian Cancer Whole-person care Quality of life Goal setting Active listening, clarifying what is important Understanding the natural disease trajectory (can be a chronic illness) Mood Coping Including caregiver, family support Dependent children Advance care planning Prognostication, “translating” medical facts Document completion

Palliative Care and Ovarian Cancer Whole-person care Symptoms from disease or its treatment Fatigue Bloating Abdominal pain Early satiety and poor appetite Nausea, vomiting Constipation, diarrhea Urinary changes Insomnia Peripheral neuropathy Shortness of breath Malignant bowel obstruction (medical management)

Hospice versus Palliative Care Palliative Care is the “umbrella” term Care can be provided at any point in illness – concurrent with aggressive and curative treatments Hospice is a subset of Palliative Care Interdisciplinary care provided in the last six months of life Patient must forgo treatments with curative intent

Hospice Includes: Interdisciplinary care Medical care Counseling Spiritual care Volunteer services Bereavement services Medical appliances and supplies Drugs for symptom and pain relief Short-term inpatient, residential and/or respite care Homemaker/home health aide http://www.nhpco.org

Primary Hospice Admission Diagnosis In 2011: 83% are 65 years or older 56% are female 83% White and 94% non hispanic National Hospice and Palliative Care, Facts and Figures on Hospice Care, 2019

Hospice Care 48.2% of hospice patients died at “home” in 2017 Hospice can also be provided in nursing facilities, adult family homes, etc National Hospice and Palliative Care, Facts and Figures on Hospice Care, 2019

Hospice Myths Hospice pays for all medical care Hospice provides: a place to live 24-hr, in-person care You can’t see your primary care or oncologist Once you join hospice, you can’t stop Everyone has a morphine drip

What Could Palliative Care Do For You?