University Hospital of Heidelberg
Implementation of a palliative care consultation for patients with advanced cancer considered for oncological phase I-trials at the National Centre for Tumour Diseases (NCT Heidelberg University): a qualitative study
Palliative care is still traditionally delivered late, if at all, in the course of advanced cancer e.g. when disease-modifying treatments have been exhausted. Various studies show an improvement in quality of life and even survival by integrating palliative care early in the course of disease. This has led to specific recommendations from oncological societies. There is still a gap between these recommendations and current practice. As the NCT is one of the largest comprehensive cancer centres (CCC) in Germany, many national and international patients with incurable cancer seek the expertise of the centre’s oncologists also for experimental treatment after all other treatment options have failed. This most vulnerable patient group is at special risk of unrealistic expectations and therefore overtreatment. Oncologists in a CCC are thus under considerable professional and emotional pressure and tend to sustain an optimistic view of treatment options and prognosis, too. In this setting advance care planning is often hindered. In addition, patients with advanced cancer often suffer from high symptom burden and are prone to unexpected treatment toxicity. Thus supportive care may be challenging. Many trials including “best supportive care” (BSC) do not consider best practice standards and/or are not intended to study BSC. As a consequence, patients’ symptoms may be undertreated.
Explore enablers and barriers for the implementation of this kind of consultation and the integration of palliative care in oncological trials at a comprehensive cancer centre.
Semi-structured interviews with patients; focus group of oncologists.
Improve quality of care in patients with advanced cancer, support honest communication, facilitate the integration of palliative care in a comprehensive cancer centre