KS-012049 eCQ 10-2 Newsletter

National Guidelines Updated to Emphasize Cancer Patients’ Needs for Palliative Care and Transition to Hospice

recommends intensifying palliative care interventions if patients and families do not experience benefits, such as reduced distress, decreased caregiver burden, and optimized QOL. UPDATES TO PALLIATIVE CARE GUIDELINES The 2017 updates reflect the panel members’ desire to emphasize the need to support patients through care transitions and EOL care. Changes to the guidelines include: • An algorithm page previously titled more broadly was renamed “Prepar- ing Patients and Families for End of Life and Transition to Hospice Care.” This change streamlines suggestions and emphasizes patients’ need for support during the transition to EOL care and hospice services. • “Refer to hospice agencies” is now the first recommendation for patients with shorter prognoses. This change highlights the importance of an early referral to hospice. • Patients with a life expectancy of “months to weeks” were added to the group previously containing only patients with a prognosis of “weeks to days.” This may help cancer patients receive hospice and other EOL care earlier in their disease course. The NCCN panelists also stressed the need to consistently communicate with patients and families about goals, values, and expectations, which are likely to shift throughout the disease course. The complete version of the updated NCCN Guidelines for Palliative Care can be found at www.NCCN.org. Source: “NCCN Guidelines Insights Palliative Care, Version 2.2017: Featured Updates to the NCCN Guidelines,” Journal of the National Comprehensive Cancer Network; August 2017; 15(8):989–997. Dans M, Smith T, Back A, Scavone JL, et al; National Comprehensive Cancer Network, Fort Washington, Pennsylvania.

A not-for-profit alliance of 27 leading U.S. cancer centers has issued its latest Clinical Practice Guidelines in Oncology, including guidelines recommending early hospice and palliative care. The National Comprehensive Cancer Network (NCCN) updates its guidelines at least annually, based on a review of the most recent clini- cal evidence by its interdisciplinary panel of experts in the field. “These recommendations were revised to provide clearer guidance for oncolo- gists as they care for patients with cancer who are approaching the transition to end-of-life (EOL) care,” write the authors of an article published in the NCCN’s of- ficial journal. “Recommendations for interventions and reassessment based on estimated life expectancy were streamlined and repriori- tized to promote hospice referrals and im- proved EOL care,” continue the authors, whose article discusses highlights of the revised guideline’s goals and changes. CANCER PATIENTS’ NEED FOR PALLIATIVE CARE The stance of the NCCN is that im- proved access to palliative care and hospice may help cancer patients and their families deal with symptoms and challenges. “Generally speaking, earlier incorpora- tion of palliative care in the cancer care continuum has been associated with im- proved EOL outcomes,” write the authors. “Palliative care has been shown to reduce symptom burden, improve quality of life (QOL), and increase the odds of dying at home.” In addition, they note, multiple studies have shown that hospice care is associated with QOL benefits including fewer hospitalizations, fewer invasive procedures, and less high-intensity care. Many cancer patients still receive ag- gressive treatment near the EOLand do not receive hospice care early enough, which is cause for concern, the authors note. In

2014 the median length of stay for hospice patients was only 17.4 days, and more than one-third of hospice patients were en- rolled for seven days or fewer. “Targeted interventions may lead to enhanced use of hospice care and improved EOL experi- ences for patients and their families,” the authors suggest. NCCN RECOMMENDATIONS The NCCN provides an algorithm to help clinicians apply important steps of palliative care at the appropriate time dur- ing the disease trajectory. The following are some of the updated palliative care recommendations for clinicians, based on the patient’s prognosis. • Patients with an estimated prognosis of years, or years to months. Assess the patient’s and family’s awareness of prognosis and disease course. Engage in regular discussions about prognosis, ad- vance care planning, and the potential for a surrogate decision-maker. Assess the patient’s and family’s values and pref- erences. Assess the need for specialized palliative care or hospice care.When the patient has a prognosis of 6 to 12months, consider having a “hospice information” visit to ease the care transition. • Patients with an estimated prognosis of months to weeks, or weeks to days. “Referral to hospice agencies should be a priority,” state the authors. Assess pa- tient/family understanding of the dying process, and educate those who desire to know more. Consider the need for care transitions, while keeping patients’ pri- mary care and oncology teams involved. Be prepared to offer information or referrals for psychosocial assessment, grief counseling, funeral planning, and other support. Keep the goals and needs of patient and family in mind. Ensure the patient does not die alone unless that is their established preference. The NCCN suggests regular reas- sessment and clear communication. It

Volume 10, Issue 2

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