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How to Establish a Palliative Care Program

Cancer

New Cases/Year
1,268,000 estimated new cancer cases in US in 2001

Cancer Related Deaths/Year
553,400 estimated cancer deaths in US in 2001

Survival Has Not Been Altered by Therapy
Newer treatments have not changed survival:

  1. Improvements in overall 5-year survival rates for cancer reflect earlier diagnosis rather than overall improvements in treatment.

  2. Ref: Welch HG, Schwartz LM, Woloshin S. Are increasing 5-year survival rates evidence of success against cancer? JAMA 2000:283;2975-2978.
  3. Fewer than 6% of all serious cancers that are not amenable to surgery are cured by chemotherapy alone. For most of the remaining 94%, chemotherapy has not been shown to prolong life.

  4. Ref: Smith TJ, Desch CE, Hillner BE. Ways to reduce the cost of oncology care without compromising the quality. Cancer Investigation 1994;12:257-265.

Chronic illnesses, including caner, have many manifestations.

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Determining Prognosis Previous Page
Cancer Next Page
Next Page Manifestations


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CAPCManual Attribution:  von Gunten CF, Ferris FD, Portenoy RK, Glajchen M, eds. CAPCManual: How to Establish A Palliative Care Program. New York, NY: Center to Advance Palliative Care, 2001.   © Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001

Permission to reproduce for non-commercial educational purposes with display of attribution and copyright is granted.
Last updated: February 20, 2002

Rationale
Select section:
Changing Illness Experience
Changing Expectations and Needs
Progressive Healthcare Response
Responding to the Opportunity

•  Changing Illness Experience
      Illness in the Past
      Progress Fighting Disaese
      Illness Today
         Prolonged Illness Experience
            Chronic Disease Process
               Determining Prognosis
               Cancer
            Manifestations
            Predicament
         Prolonged End-of-life Experience
            Sudden Unexpected Death
            Predictable Decline
            Slow Decline, Multiple Acute Crises
         Death in the US
            Leading Causes of Death
            Setting of Death
               Desired
               Reality
         Multiple Issues Cause Suffering
            The Square of Care
            Morbidity
               Pain
               Need for Assistance
               Social, Financial Impact
         Implications for Care
            Variable Need for Care
            Opportunities
               For Patients
               For Families
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•  Changing Expectations and Needs
      Increased Consumer Autonomy
         Picker Institute 8 Dimensions of Care
      Goals, Not Problems, Drive Care
         Shift to Goal-oriented Care
      Expect Competence, Expertise
      Expect Comprehensive Assessment
      Expect Effective Communication
      Expect Participation in Decision-making
      Expect Timely, Continous, Coordinated Care Delivery
      Expect Assistance with Caregiving
         Caregiver Training, Support
         Caregiver Financial Support
         Alternate Settings of Care
         Respite Relief
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•  Progressive Healthcare Response
      Focus on Disease-modifying Therapy
      Focus on Care of the Dying
         Early Hospice
         Modern Hospice Movement
            Dame Cicely Saunders
            Origins of "Palliative Care”
         Evolution of Hospice, Palliative Care
            In United Kingdom
            In Canada
            In United States
            Convergent Evolution
         Hospice, Palliative Care in US Today
            Hospice Growth
      Continued Unmet Opportunity
      A Public Health Issue
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•  Responding to the Opportunity
      Paradigm Shift in Thinking
      Provide Concurrent Care
      Consider Application to Those at Risk
      Expand Services, Settings of Care
      1º, 2º, 3º Model of Delivery
      Expand Access to Expertise
      Create Specialized Environments
      Many Names, Same Focus of Care
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