What are the NCCN guidelines for delivery of palliative care?

Updated: Aug 13, 2018
  • Author: Winston W Tan, MD, FACP; more...
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Answer

Answer

The National Comprehensive Cancer Network (NCCN) concurs and includes the following additional recommendations [6] :

  • All cancer patients should be repeatedly screened for palliative care needs, beginning with their initial diagnosis and thereafter at intervals as clinically indicated
  • Palliative care should be initiated by the primary oncology team and then augmented by collaboration with palliative care experts
  • All health care professionals should receive education and training to develop palliative care knowledge, skills, and attitudes
  • An interdisciplinary team of palliative care specialists should be available to provide consultation or direct care to patients and/or families as requested or needed
  • Quality of palliative care should be monitored by institutional quality improvement programs

The NCCN recommends assessment by the oncology team for patients whose screening confirms the presence of one or more of the following [6] :

  • Uncontrolled symptoms
  • Moderate-to-severe distress related to cancer diagnosis and cancer therapy
  • Serious comorbid physical, psychiatric, and psychosocial conditions
  • Patient, family, or caregiver concerns about the course of disease and decision-making
  • Patient/family requests for palliative care
  • Metastatic solid tumors and refractory hematologic malignancies
  • Potentially life-limiting disease

Additional indicators may include the following:

  • Poor performance status – Eastern Cooperative Oncology Group (ECOG) score ≥3 or Karnofsky Performance Status (KPS) score ≤50
  • Persistent hypercalcemia
  • Brain or cerebrospinal fluid metastasis
  • Delirium
  • Malignant bowel obstruction
  • Superior vena cava syndrome
  • Spinal cord compression
  • Cachexia
  • Malignant effusions
  • Palliative stenting or venting gastrostomy

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