A step towards dignity in life and death.

Abstract

All too many patients with cancer will die in pain, fear, or confusion, or with goodbyes unsaid, having spent the last few months of their lives experiencing treatment-related adverse events. With most patients given the highest amount of chemotherapy treatment during their last months of life, it seems that we have forgotten that extension of life at any cost is a price not worth paying. If the goal of evidence-based medicine is the use of research for people to live their lives in the best possible health, surely we should also use research to establish how patients can also have the best possible death. When a patient is diagnosed with cancer, part of their provision of care must be to plan for amelioration of adverse events or the possibility of their treatment not working, and to have careful, structured dialogues with them and their loved ones about how they would like to proceed in such eventualities. It is the steps needed to make this goal a reality that Stein Kaasa and colleagues address in The Lancet Oncology's latest Commission. 1 Kaasa S Loge JH Aapro M et al. Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol. 2018; (published online Oct 18.)http://dx.doi.org/10.1016/S1470-2045(18)30415-7 Summary Full Text Full Text PDF PubMed Scopus (178) Google Scholar Integrating palliative care into health systems is essential to achieve Universal Health CoveragePalliative care and pain relief have been largely ignored in global health.1 The Lancet and The Lancet Oncology have taken up this gauntlet by releasing two Commission reports2,3 that provide roadmaps to close the growing abyss in access to palliative care and pain relief for large parts of the world.4,5 Full-Text PDF Oncology and palliative care: patients need a seamless serviceIn The Lancet Oncology Commission,1 Stein Kaasa and colleagues lay out their purpose clearly: “to show why and how palliative care can be integrated with oncology for adults with cancer, irrespective of treatment intention”. The first part of this manifesto is more clearly fulfilled than the second. To marshal the modest, but accumulating, evidence for better patient outcomes when oncology and palliative care work in synergy is straightforward,2–6 but to say how integration between the specialties should be achieved is much harder, given the variations between countries in health-care organisation and culture. Full-Text PDF Integration of oncology and palliative care: less-mentioned issues and a Japanese perspectiveWe welcome the comprehensive Lancet Oncology Commission1 by Stein Kaasa and colleagues, which clarifies a reliable pathway to achieve patient-centered care through the integration of oncology and palliative care.1 Full-Text PDF Integrating palliative and oncology care: paediatric considerationsCancers that affect adults inflict a worldwide burden of suffering. Stein Kaasa and colleagues' Lancet Oncology Commission1 on the integration of oncology and palliative care highlights important developments in our understanding of the pivotal contributions of palliative care to person-focused adult cancer care. For children with cancer, additional and expanded constructs should be considered. Although childhood cancers are far less prevalent than cancers that affect adults, the need for integrated paediatric palliative care and oncology care is no less pressing. Full-Text PDF Integration of oncology and palliative care: a Lancet Oncology CommissionFull integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Full-Text PDF