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Michael H. Levy, Anthony Back, Costantino Benedetti, J. Andrew Billings, Susan Block, Barry Boston, Eduardo Bruera, Sydney Dy, Catherine Eberle, Kathleen M. Foley, Sloan Beth Karver, Sara J. Knight, Sumathi Misra, Christine S. Ritchie, David Spiegel, Linda Sutton, Susan Urba, Jamie H. Von Roenn and Sharon M. Weinstein

Palliative Care Clinical Practice Guidelines in Oncology NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Overview Palliative care is both a philosophy of care and an organized, highly structured system for delivering care to persons with life-threatening or debilitating illness. Palliative care is patient- and family-centered care that focuses on effective management of pain and other distressing symptoms, while incorporating psychosocial and spiritual care according to patient/family needs, values, beliefs, and cultures. The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of disease stage or the need for other therapies. Palliative care can be delivered concurrently with life-prolonging care or as the main focus of care. The standards of palliative care are as follows: • Institutions should develop a process ensuring that all patients have access to palliative care services from the initial visit....
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Joan S. McClure

In the past few months I have had the privilege of traveling to Japan, the United Arab Emirates, and China with groups of physicians presenting NCCN Clinical Practice Guidelines in Oncology. One particularly rewarding aspect of these experiences has been recognizing how similar the management of cancer is in these diverse areas of the world. Physicians in all areas of the world are reviewing the same literature so that, with minor changes to account for regulatory availability of agents, access to specific technologies, and metabolic and genetic differences among populations, the treatments for common cancers are very much the same. Especially gratifying is seeing the dedication that physicians in all parts of the world show to their patients.These travels have also illustrated a few significant differences, however, one of which is how physicians in different cultures talk about end of life issues with patients who have poor prognoses. In this area, when at its best, American medicine shines. In the United States, a continuum of care is becoming the “norm.” In this continuum, tumor-directed therapy continues throughout most of the course of the disease, even as its intent changes from potentially curative to palliative. Similarly, symptom management begins at diagnosis and becomes a greater focus when disease progresses. Patients, doctors, and nurses engage in ongoing conversations about both treatments and the changing goals of treatment.Initially, the goal is often to cure the disease or to extend life as long as possible. During this period, fighting the cancer is...
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discussions will look at the impact the election and a new administration could have on cancer and health policy, as well as palliative care and end-of-life issues from a patient and provider perspective. A host of other sessions will tackle topics such as

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Teresita Muñoz-Antonia

, who also may be uncomfortable discussing end-of-life issues with their physicians, lack advance directives, and prefer to have family members make these decisions. In all conversations, she added, “be sure to clarify and get a positive response

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difficult position of having to raise end-of-life issues with the patient once the prognosis becomes negative. Ms. Daulerio said that her family avoided any discussion of dying with her mother because they thought it would be too sad, but that by the time

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Michael H. Levy, Michael D. Adolph, Anthony Back, Susan Block, Shirley N. Codada, Shalini Dalal, Teresa L. Deshields, Elisabeth Dexter, Sydney M. Dy, Sara J. Knight, Sumathi Misra, Christine S. Ritchie, Todd M. Sauer, Thomas Smith, David Spiegel, Linda Sutton, Robert M. Taylor, Jennifer Temel, Jay Thomas, Roma Tickoo, Susan G. Urba, Jamie H. Von Roenn, Joseph L. Weems, Sharon M. Weinstein, Deborah A. Freedman-Cass and Mary Anne Bergman

does not have to sidetrack them from addressing end-of-life issues. Collaborating with palliative care experts extends oncologists’ therapeutic repertoire and diminishes the stress of caring for patients who have incurable disease. Increasing emphasis

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Michael H. Levy, Thomas Smith, Amy Alvarez-Perez, Anthony Back, Justin N. Baker, Susan Block, Shirley N. Codada, Shalini Dalal, Maria Dans, Jean S. Kutner, Elizabeth Kvale, Sumathi Misra, William Mitchell, Todd M. Sauer, David Spiegel, Linda Sutton, Robert M. Taylor, Jennifer Temel, Roma Tickoo, Susan G. Urba, Carin Van Zyl, Sharon M. Weinstein, Mary Anne Bergman and Jillian L. Scavone

– 277 . 61. Cohen JS Erickson JM . Ethical dilemmas and moral distress in oncology nursing practice . Clin J Oncol Nurs 2006 ; 10 : 775 – 780 . 62. Gaeta S Price KJ . End-of-life issues in critically ill cancer patients . Crit

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Amy Waller, Charles Douglas, Rob Sanson-Fisher, Nicholas Zdenkowski, Angela Pearce, Tiffany Evans and Justin Walsh

oncology patients and their support persons agree about end of life issues? Intern Med J 2018 ; 48 : 60 – 66 . 23. Waller A Sanson-Fisher R Zdenkowski N . The right place at the right time: medical oncology outpatients' perceptions of

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Siew Tzuh Tang, Tsang-Wu Liu, Fur-Hsing Wen, Chiun Hsu, Yi-Heng Chang, Cheng-Shyong Chang, Yung-Chuan Sung, Cheng-I Hsieh, Shou-Yi Chang, Li Ni Liu and Ming-Chu Chiang

. 18. Montero DM . End-of-life issues in the United States after Terri Schiavo: implications for social work practice . Adv Soc Work 2011 ; 12 : 164 – 180 . 19. Shucksmith J Carlebach S Whittaker V . Dying: discussing and planning

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Pelin Cinar, Timothy Kubal, Alison Freifeld, Asmita Mishra, Lawrence Shulman, James Bachman, Rafael Fonseca, Hope Uronis, Dori Klemanski, Kim Slusser, Matthew Lunning and Catherine Liu

services may be diminished. The role of palliative care services via telemedicine has also been shown to provide patients with additional support at home and can be used to address symptoms and end of end-of-life issues during the pandemic. 22 NCCN’s self