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FORT LAUDERDALE, Fla., Mar 03, 2001 (United Press International via COMTEX) -- A new set of treatment guidelines issued Saturday at the annual meeting of a nationwide cancer hospital network focus on providing comfort for patients with advanced cancer, acknowledging that most of them will die despite medicine's best efforts to defeat the disease.
"These are the first guidelines that mention death as an outcome," said Dr. Michael Levy, vice chairman of medical oncology at Fox Chase Cancer Center, Philadelphia. Pa.
Levy is chairman of the panel writing treatment guidelines for the 18 National Comprehensive Cancer Network member institutions.
The palliative care guidelines should be considered when a patient is first diagnosed with cancer, Levy said. Actively implementing the guidelines, however, occurs when the doctor recognizes that a patient has advanced, progressive disease and there are few, if any, effective curative therapies.
The palliative guidelines take into account that doctors still have to treat their patients until death -- and beyond.
"There are many doctors who treat cancer patients and have the attitude that 'death is an option,' that the only hope comes in the form of more chemotherapy," Levy said at the NCCN annual meeting here. "I can say that these guidelines really do offer hope. They give doctors an opportunity to help their patients' growth at the end of life."
Dr. Sharon Weinstein, associate professor of oncology at the Huntsman Cancer Institute at the University of Utah, Salt Lake City, defines palliative care as "intensive comfort care."
"Doctors and patients should not think of palliative care as giving up on a patient," Weinstein said. "Palliative care is important care, and it can be life-prolonging, but does not have to prolong suffering."
Weinstein said good palliative care also gives doctors the opportunity to work on cancer prevention, developing a relationship with family members and assessing their risks. "There are genetic, environmental and behavioral factors that can be influenced by a physician," she said.
Levy said physicians can miss these opportunities if they concentrate on adding more and more therapy in a fruitless attempt to stave off the disease.
The guidelines call for doctors to actively assess palliative care when treatment has failed, when the life expectancy of patients is less than 12 months, or when the patient requests palliative care.
In those situations, Levy said the physician should discuss several issues with the patient. These include the benefits and risks of continuing anticancer therapy; ways of controlling symptoms (including pain, fatigue and nausea, as well as sleep and eating disturbances); advanced care planning, such as writing a living will; psychosocial needs and other factors in end-of-life decisions. Physicians should discuss with patients "what a good death looks like" and "what the patient wants to accomplish with the rest of his life," Levy said.
Doctors who treat patients with early-stage breast, colon, skin and prostate cancer can offer their patients a good chance of curative treatment, Levy said. But when cancer specialists see advanced patients, they have to realize that more than 90 percent of them are going to die under the doctor's care, he said, and decisions about palliative treatment have to be made early on in the relationship.
Other NCCN institutions include Memorial Sloan-Kettering Cancer Center in New York City, MD Anderson Cancer Center in Houston and Stanford Hospital and Clinics in California.
By ED SUSMAN, UPI Science News
Copyright 2001 by United Press International.
SUBJECT CODE: 07000000 14000000
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