1. 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

2. No disclosures

3. HAVE YOU EXPERIENCED PALLIATIVE CARE?

4. 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.

5. Palliative Care: Bridge Repair

6. 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):
Parikh, N Engl J Med 369;24 December 12, 2013

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

8. 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)

9. Palliative Care and Ovarian Cancer

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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

16. 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

17. What Could Palliative Care Do For You?