Speaker: Kathleen M. Foley, M.D., Memorial Sloan Kettering Cancer Center
Co-Chairs: Nora Janjan, M.D., University of Texas, M.D. Anderson Cancer Center Ruth McCorkle, R.N., Ph.D., F.A.A.N., Yale University School of Nursing
Research on treatment- or cancer-related distress has not targeted older cancer patients as a group, even though persons aged 65 years and older experience most of the cancer burden. As a result, knowledge about measures of pain and other types of symptom control and palliative care in older cancer patients is limited. Moreover, palliative care in most adult age groups in the United States has not reached its full potential; attention to this issue is critically important, as 20 percent of the American population will be aged 65 years and older in less than three decades (by 2030). Accelerated strides in cancer therapy have tended to blur the distinction between hope for a cure and recognition that cancer is a terminal illness. In fact, cancer is often considered a chronic disease. However, recent advances in cancer treatment still require aggressive symptom management as well as psychological, social, and spiritual support throughout all phases of cancer diagnosis and treatment in all age groups. Supportive and palliative care is essential for managing the complications of cancer and its treatment at any stage of the disease. In addition, the psychosocial care of patients and families and care of the dying must be addressed.
Two key national studies have evaluated these issues. The first, a National Cancer Policy Board (NCPB) study, responded to the 1997 Institute of Medicine (IOM) report, Approaching Death: Improving Care at the End of Life, which discussed a range of end-of-life issues. This report received national attention and is now regarded as a milestone in palliative care. Opportunely, the NCPB report Improving Palliative Care for Cancer: Summary and Recommendations was issued by the IOM the week after the NIA/NCI cancer centers workshop. Two cancer center workshop participants, Dr. Kathleen M. Foley, the speaker for Working Group 6, and Dr. Charles S. Cleeland, a participant in Working Group 6, contributed to the NCPB report, which is an excellent resource for all initiatives generated from the priorities of Working Group 6.
Following the lead of the NCPB, Working Group 6 adopted the World Health Organization definition of palliative care as "the active total care of patients whose disease is not responsive to curative treatment." Control of pain; other symptoms; and psychological, social, and spiritual problems are of paramount importance in palliative care, whose goal is to achieve the best quality of life for patients and their families.
In her introductory remarks at the NIA/NCI cancer centers workshop, Dr. Foley indicated that the term palliative care was formerly associated with patients who were clearly near the end of life. In Dr. Foley's view, more comprehensive definitions of palliative care should address the multidimensional aspects—interpersonal, physical, psychological, social, and spiritual—of patients and their families. The primary objective of palliative care is to enhance the quality and meaning of life and death.
The lessons learned from palliative care in the older population can apply to all patients. The research priorities of Working Group 6 represent broad-based, epidemiologic studies and translational health services research. The outcomes of the proposed research may improve tolerance of therapy and supportive care and increase participation of the elderly in clinical trials.
The NCPB report's summary and recommendations include a special focus on the contribution that cancer centers, in particular, could make to palliative care research. According to the NCPB, "NCI-designated cancer centers should play a central role as agents of national policy in advancing palliative care research and clinical practice, with initiatives that address many of the barriers identified in this report." The activities recommended for cancer centers in palliative research include the following examples:
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