Division of Neoplastic Diseases and Related Disorders, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Cancer J. 2010 Sep-Oct;16(5):488-92. doi: 10.1097/PPO.0b013e3181f28ae6.
The interdisciplinary team is fundamental to the successful delivery of quality palliative care. Ideally, the oncologist is an integral part of either the palliative care or hospice team and serves to maintain continuity of care through the end of life. In the United States, barriers can complicate the oncologist's easy integration into the hospice team as patients often remain at home. Also, there may be philosophical or clinical practice differences between oncology and palliative care at first glance. This article focuses on ways to overcome these potential obstacles and use differences in training to strengthen the team's impact. A significant part of oncology practice includes managing difficult symptoms, mitigating suffering, and discussing priorities of care--all elements of palliative medicine that oncologists perform daily. Participating on a palliative care team may be natural for oncologists, and some might elect to provide integrated palliative cancer care for patients throughout the course of their disease and at the end of life. Thus, there is a need to enrich the general oncologist's knowledge of specialized palliative medicine, as recommended by the major cancer organizations, including the American Society of Clinical Oncology and the European Society of Medical Oncology.It is important to know when to incorporate a palliative or hospice care team into the routine management of a cancer patient and what benefits these referrals can provide. Oncologists have an obligation to provide high-quality palliative care to all patients in an integrated fashion, including patients with advanced cancer enrolled in clinical trials for early therapeutics.
跨学科团队是提供高质量姑息治疗的基础。理想情况下，肿瘤学家是姑息治疗或临终关怀团队的一个组成部分，通过生命末期来维持护理的连续性。在美国，由于患者通常在家中，肿瘤学家很难轻易融入临终关怀团队，这会造成一些障碍。此外，肿瘤学和姑息治疗在初看上去可能存在哲学或临床实践方面的差异。本文重点讨论了克服这些潜在障碍的方法，并利用培训方面的差异来加强团队的影响力。肿瘤学实践的一个重要部分包括管理困难的症状、减轻痛苦以及讨论护理重点——所有这些都是肿瘤学家每天都在进行的姑息医学的要素。参与姑息治疗团队对肿瘤学家来说可能是自然而然的，一些人可能会选择为患者提供贯穿疾病全程和生命末期的综合姑息癌症治疗。因此，有必要丰富普通肿瘤学家对专门姑息医学的知识，这是包括美国临床肿瘤学会和欧洲肿瘤内科学会在内的主要癌症组织所推荐的。了解何时将姑息或临终关怀团队纳入癌症患者的常规管理以及这些转介可以提供哪些益处非常重要。肿瘤学家有义务以综合的方式为所有患者提供高质量的姑息治疗，包括参加早期治疗临床试验的晚期癌症患者。
