Integrating Effective Palliation For Patients with Lung Cancer

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Integrating Effective Palliation For Patients
with Lung Cancer

• Aileen Collier

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WHO definition- Palliative Care

• Palliative care is an approach that improves
  the quality of life of patients and their
  families facing the problems 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.
• (Sepulveda et al, 2002)

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Lung Cancer The Issues

• Poor Prognosis
• Stigma pts feel blamed for their illness whether
  or not they smoked (Chapple et al 2004)
• Unmet Psychological, Physical Functional Needs
  (Li and Girgis, 2006)
• A Sense of Nihilism Its a Death Sentence The
  Guilt
• Nothing can be Done!
• Significant Complex Symptom Burden

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Advanced Lung Cancer symptoms

• Fatigue 47-82
• Breathlessness 46-87
• Cough 77-86
• Chest Pain 37-57
• Weight Loss(gt/10) 18-39
• Weight Loss (gt5) 60-82
• Psychological Distress 33-44
• Soni et al(2002)

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Symptom management

• Symptoms are often a constellation of states
  of mind and body where problems such as pain,
  breathlessness, fatigue, anxiety or depression
  are often experienced simultaneouslyeach problem
  related to and often difficult to distinguish
  from all others
• Jessica Corner(2004)

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Complex Symptoms Particular To Lung Cancer

• Haemoptysis
• Superior Vena Cava Obstruction
• Post Obstructive Pneumonia
• Brachial Plexus Pain
• Pancoast Syndrome

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• A concerning level of depressive symptoms
  especially in patients with poor performance
  status..indicating that psychological status of
  lung cancer patients needs to be systematically
  addressed in their overall management
• Hopwood and Stephens (2000)

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Models of Palliative Care
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Simultaneous Care(Meyers and Linder)

• The explicit acknowledgement and relief of
  suffering and distress needs to be a component of
  care in virtually all patient/physician/health
  system interactions

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Characteristics of simultaneous care

• Concurrent anticancer treatment and palliative
  care.
• Palliative Care begins at the first contact
• Grows in importance over the course of the
  disease
• Reiteration of non-abandonment explicit
  assurance of best care possible.

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• What Is The Context of Your Work?

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• Aggressive Palliation
• (Silvestri et al, 2002)

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Every Nurses Business !

• Ferrell and Coyle(2006)
• Every nurse should be a palliative care nurse

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The contributors to Effective Palliation

• Medical Oncologist
• Palliative Medicine Physician
• Chemotherapy Nurses
• Dietician
• Physiotherapist
• Lung Cancer Care Coordinator
• Local Community Palliative Care Team
• GP

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Care Coordinators Role

• Communication, information and support
• Being in the space
• Look for a windowreferral to palliative care
• Advocate
• Point of contact /open access for Jane and her
  husband.
• Symptom control
• Liaison and communication between Jane, James,
  Oncologist, SPCTs, GP, dietician, physio

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Facilitating End of Life Discussions with Lung
Cancer Patients

• Pilot study of 15 patients
• Horne et al (2006) ACP intervention guide
• Nurse attributes aided discussion about future
  care and treatment
• Patients appreciated the explanation and
  information offered to them
• Accepted the recording of their preferences

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• Its not that Im afraid to die.. I just dont
  want to be there when it happens
• Woody Allen

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Redressing the Balance

• Truly Multidisciplinary Lung Cancer Teams
• Specialist Lung Cancer Nurses
• Awareness raisingLung Net Australian Lung
  foundation
• Timely Referral to Specialist Palliative Care
  Team based on need rather than prognosis
• Lung Cancer Specific Support Groups
• Nutrition And Rehabilitation pilot clinic.
• Implementing Clinical Pathways

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Conclusions

• Advocate Simultaneous Care (need not prognosis)
• Best use of limited resources by Specialist
  Palliative Care Teams
• Creative collaboration between Oncology and
  Specialist Palliative Care Teams
• Nurse Led Initiatives
• Raise Awareness to Advance Care

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