Annals of Oncology 12:443-450, 2001
© 2001 European Society for Medical Oncology
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Palliative medicine and medical oncology
1Palliative Care Unit, Department of Oncology, City Hospital ‘L Pierantom’ Forli Italy
2Department of Oncology, City Hospital ‘L Pierantom’ Forli Italy
Correspondence to: Marco Maltoni, MD, Palliative Care Unit - Oncology Department, City Hospital ‘L. Pierantoni’, Via Forlamni, 34, 47100 Forli, Italy E-mail malto.ma{at}tin.it
Traditionally, medical oncology and palliative care have been considered two distinct and separate disciplines, both as regards treatment objectives and delivery times Palliative care in terminal stages, aimed exclusively at evaluating and improving quality of life, followed antitumor therapies, which concentrated solely on quantitative results (cure, prolongation of life, tumoral mass shrinkage) Over the years, more modern concepts have developed on the subject Medical oncology, dealing with the skills and strategic co-ordination of oncologic interventions from primary prevention to terminal phases, should also include assessment and treatment of patients' subjective needs Anticancer therapies should be evaluated in terms of both the quantitative and qualititative impact on patients' lives. Hence, the traditional view of palliative care has to be modified it constitutes a philosophical and methodological approach to be adopted from the early phases of illness. It is not the evident cultural necessity of integrating medical oncology with palliative medicine that may be a matter of argument, but rather the organizational models needed to put this combined care into practice should continuous care be guaranteed by a single figure, the medical oncologist, or rather by an interdisciplinary providers' team, including full-time doctors well-equipped for palliative care? In this paper the needs of cancer patients and the part that a complete oncologist should play to deal with such difficult and far-reaching problems are firstly described Then, as mild provocation, data and critical considerations on the ever increasing needs of palliative care, the present shortcomings in quality of life and pain assessment and management by medical oncologists, and the uncertain efficacy of interventional programmes to change clinical practice are described Finally, a model of therapeutic continuity is presented, which in our view is realistic and feasible- an Oncologic Programme as the unifying process, and the Comprehensive Cancer Centre, or the Oncologic Department, the delivering structure
comprehensive cancer centre, medical oncology, oncology department, palliative medicine
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