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L1 Integration of oncology and palliative care: a review of its history and directions for the future
  1. Stein Kaasa
  1. University of Oslo/Oslo University Hospital/Director of the European Palliative Care Research Center, Norway


Integration of oncology and palliative care combine two main paradigms, the tumour (anti-cancer) and the patient (host) directed approaches. There is strong evidence supporting such integration at organizational levels, at the level of systematic patient centered care approaches (systematic use of patient reported outcome measures (PROMs)) and at the level of family by improving satisfaction and quality of life. In principle to succeed, the evidence proven systems and treatments need to be implemented into daily clinical practice. But there are barriers for successful implementations at organizational and individual health care provider levels. For optimal use of resources, both the oncology care and palliative care pathways need to be well planned. Patient centered care pathways can be used as an implementation method.

The WHO definition of palliative care states that the competence, attitudes and skills of palliative care should be integrated early in the course of the illness. Attention to cancer palliative care emerged in the 1970s. At that time, palliative care had a strong focus on end of life care. Supportive care emerged as a concept in the late 1980s as new needs were identified. Models of integration of oncology and palliative care were tested in several randomized studies resulting in strong recommendations of early palliative care supported by WHO, ESMO and ASCO. One challenge is to translate the content of the interventions into clinical practice.

How to proceed?

National and international actions need to be taken. Health care providers need to have sufficient training in palliative care at basic, advanced and specialist levels according to how and how much they practice palliative care. To succeed in making changes in health care a complex interventional approach need to be applied: Medical cultures need to be understood, involvement of leaders in oncology and palliative care needs to take place, international standards are needed, patient centered care needs to be actively implemented in oncology and sufficient funding and priorities need to be available.

Modern information and communication technology (ICT) can be used to develop digital patient-centred care pathways (dPCCP) supplemented by digital patient reported outcome measures (PROMs). This combination of patient-centred care—ICT solutions—will be developed, tested and implemented into cancer care. The EU funded project—MyPath—consisting of 14 partners will develop a digital solution for patient-centred care, consisting of digital patient-centred care pathways (dPCCP), patient reported outcome measures (PROMs) and patient reported experience measures (PREMs), as well as computer based decision support.

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