Assistant Professor of Psychology, Harvard Medical School, and Assistant in Psychology, Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
CA Cancer J Clin. 2013 Sep;63(5):349-63. doi: 10.3322/caac.21192. Epub 2013 Jul 15.
Scientific advances in novel cancer therapeutics have led to remarkable changes in oncology practice and longer lives for patients diagnosed with incurable malignancies. However, the myriad options for treatment have established a culture of cancer care that has not been matched with a similar availability of efficacious supportive care interventions aimed at relieving debilitating symptoms due to progressive disease and treatment side effects. Accumulating data show that the introduction of palliative care services at the time of diagnosis of advanced cancer leads to meaningful improvement in the experiences of patients and family caregivers by emphasizing symptom management, quality of life, and treatment planning. In this review article, the rationale and evidence base for this model of early palliative care services integrated into standard oncology care are presented. In addition, the implications and limitations of the existing data to 1) elucidate the mechanisms by which early palliative care benefits patients and families; 2) guide the dissemination and application of this model in outpatient settings; and 3) inform health care policy regarding the delivery of high-quality, cost-effective, and comprehensive cancer care are discussed.
新型癌症治疗方法的科学进步导致肿瘤学实践发生了显著变化，使被诊断为无法治愈的恶性肿瘤的患者的寿命延长。然而，治疗方法的多样性已经建立了一种癌症护理文化，但这种文化并没有与同样有效的支持性护理干预措施相匹配，这些干预措施旨在缓解由于疾病进展和治疗副作用导致的衰弱症状。越来越多的数据表明，在晚期癌症诊断时引入姑息治疗服务，通过强调症状管理、生活质量和治疗计划，可显著改善患者和家庭照顾者的体验。在这篇综述文章中，介绍了将这种早期姑息治疗服务模式纳入标准肿瘤学治疗的基本原理和证据基础。此外，还讨论了现有数据在以下方面的意义和局限性：1）阐明早期姑息治疗使患者和家庭受益的机制；2）指导该模型在门诊环境中的传播和应用；3）为提供高质量、具有成本效益和全面的癌症护理的医疗保健政策提供信息。
