Integration of palliative care into standard oncology practice in the Czech Republic.

Background: Patients with advanced cancer experience symptoms that worsen quality of life (QoL). Palliative care (PC) is traditionally applied after antineoplastic therapy. A concept of early integration of palliative care (EPC) into standard oncology practice, has been shown to provide benefits for QoL, symptoms, and survival. However, successful integration of PC into oncological practice is related to specific features of health care systems. The aim of our project is to monitor the access to PC in cancer centers in the Czech Republic and to test the feasibility of integration of EPC under circumstances of a Czech health care system. 

Methods: The presented study is a national survey conducted in 13 cancer centers in the Czech Republic. These are the centers of excellence of Czech oncological care. The survey was online platform focused on the provision and access to services of supportive and palliative care. Firstly we asked on integration of specialists in PC, pain, nutrition, rehabilitation, social, psychological and spiritual care and established PC teams in these centers. The second part were questions on use of these services in patients undergoing anticancer therapy. In the last part were questions on typical direction of patients after anticancer therapy has ceased. 

Results: In Czech cancer centers are integrated PC specialists in 4 of them. Other supportive care specialists are integrated more frequently: pain 7, nutrition 9, rehabilitation 7, psychology 9, social and spiritual care 8. The proportion of patients who used palliative/supportive care services during curative treatment is: pain 24,5%, nutrition 23,5%, psychology 14,5%, social 42%, and spiritual care 16,5%. After termination of anticancer therapy is 47% patients followed and treat in cancer centers. From the rest is 13,5% directed to PC outpatient clinics, to GP 16,5%, to inpatient hospice care 12,5%, and to home hospice care 10,5%. 

Conclusions: Access to palliative care in Czech cancer centers is very low. Education and dissemination of goals of PC can improve this situation. For this purpose we will start a prospective randomized controlled trial of early integration of palliative care into standard oncology practice in newly diagnosed metastatic cancers.

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Citation:
J Clin Oncol 32, 2014 (suppl; abstr e20546)