American Society of Clinical Oncology Statement: Toward Individualized Care for Patients With Advanced Cancer

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 02/2011; 29(6):755-60. DOI: 10.1200/JCO.2010.33.1744
Source: PubMed


Patients with advanced incurable cancer face complex physical, psychological, social, and spiritual consequences of disease and its treatment. Care for these patients should include an individualized assessment of the patient's needs, goals, and preferences throughout the course of illness. Consideration of disease-directed therapy, symptom management, and attention to quality of life are important aspects of quality cancer care. However, emerging evidence suggests that, too often, realistic conversations about prognosis, the potential benefits and limitations of disease-directed therapy, and the potential role of palliative care, either in conjunction with or as an alternative to disease-directed therapy, occur late in the course of illness or not at all. This article addresses the American Society of Clinical Oncology's (ASCO's) vision for improved communication with and decision making for patients with advanced cancer. This statement advocates an individualized approach to discussing and providing disease-directed and supportive care options for patients with advanced cancer throughout the continuum of care. Building on ASCO's prior statements on end-of-life care (1998) and palliative care (2009), this article reviews the evidence for improved patient care in advanced cancer when patients' individual goals and preferences for care are discussed. It outlines the goals for individualized care, barriers that currently limit realization of this vision, and possible strategies to overcome these barriers that can improve care consistent with the goals of our patients and evidence-based medical practice.

Full-text preview

Available from:
    • "Independent of when GOC discussions are introduced, participants strongly advocated for a systematic process-oriented approach that includes multiple conversations over time, dedicated time to initiate and engage in discussion, documentation tools and system cues to alert the physician about the need to initiate, continue or revisit the ACP discussion. This orientation to ACP is well supported in the literature78918]. Best practice guidelines support family involvement in ACP, with patients deciding the level of family involvement and then inclusion of all in the development of an ACP plan[8,18]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite evidence that Goals of Care (GOC) discussions should occur early in the disease trajectory, the majority occur close to end of life. In a pilot, oncologists routinely initiated GOC discussions with all patients in their everyday ambulatory practice. Following the pilot, 9 of 12 eligible oncologists participated in semi-structured interviews about their experiences. Analysis resulted in the identification of seven principles of good GOC discussions embedded in the oncologists' interviews, four barriers to engaging in GOC discussions and foundational education needs. Participants believed that the appropriate trigger for a GOC discussion is a diagnosis of advanced cancer, not simply a diagnosis of cancer, and supported the importance of selective and strategic targeting of GOC discussions. The findings have informed the development of an education-based model for culture change within a province-wide cancer care system.
    No preview · Article · Sep 2015 · Journal of Cancer Education
  • Source
    • "Les soins palliatifs ont réussi à être reconnus comme bénéfiques pour les patients et leurs familles, en améliorant la qualité de vie, mais aussi la survie des patients pris en charge précocement [22,23,50]. Plusieurs régions pilotes ont pu développer des programmes pour permettre l'accès au plus grand nombre de patients sans augmentation des dépenses [13]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Palliative medicine is a recent discipline with a development that occurs outside of academic institutions, proposing a new vision of care focused on patients’ and caregivers’ needs. After a short summary of palliative medicine history, we will describe the current situation and the challenges and opportunities of the next 10 years. We shall describe clinical development and its organization. One of the main challenges of the future for palliative care will be to provide appropriate care tailored to the needs of the population and also to strengthen collaboration with other disciplines. The aim is to enable patients to have access to palliative care when needed and not only at end of life. This can be done not only through the development of structures and clinical strategies but also through a centralized administration to provide quality and shared information on patients’ situation. We shall then propose a vision for the development of education and research and the challenges to raise palliative medicine status to academic medicine and evidence based medicine. Finally, we shall propose a model for the development or rather the culture change for the integration of a “palliative attitude”.
    Full-text · Article · Oct 2012 · Médecine Palliative Soins de Support - Accompagnement - Éthique
  • Source
    • ")에서 항암제 투여 및 암환자 간호와 관련된 실무지침을 개 정하고 제공하여(Azzoli et al., 2011; Peppercorn et al., 2011 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: This study was done to develop tool to evaluate the core competencies regarding nursing cancer patients on chemotherapy, and to verify the reliability and efficacy of the developed tool. Methods: A tool to evaluate the core competencies was developed from a preliminary tool consisting of 112 items verified by expert groups. The adequacy of the preliminary tool was analyzed and refined to the final evaluation tool containing 76 items in 8 core competencies and 18 specific competencies. The evaluation tool is in the form of a self-report, and each item is evaluated according to a 3-point scale. From September 22 to October 14, 2011, 349 survey responses were analyzed using SPSS 20.0 and the WINSTEPS program that employs the Rasch model. Results: Results indicated that there were no inappropriate items and the items had low levels of difficulty in comparison with the knowledge levels of the study participants. The results of factor analysis yielded 18 factors, and the reliability of the tools was very high with Cronbach's α=.97. Conclusion: The results of this study can be used for training and evaluation of core competencies for nursing cancer patients, and for standardizing nursing practices associated with chemotherapy.
    Preview · Article · Oct 2012 · Journal of Korean Academy of Nursing
Show more