Palliative Chemotherapy Dr. Oscar S. Breathnach Consultant Medical Oncologist Palliative Care Multidisciplinary Study Day Beaumont Hospital Sept. 19 th,

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Presentation transcript:

Palliative Chemotherapy Dr. Oscar S. Breathnach Consultant Medical Oncologist Palliative Care Multidisciplinary Study Day Beaumont Hospital Sept. 19 th, 2013

You have been diagnosed with CANCER ADVANCED CANCER

OUTCOME PATIENT [ mind- body-spirit ] FAMILY / FRIENDS MEDIA / INTERNET MEDICAL / NURSING STAFF Life Events Belief Systems Cultural Environment

Cancer, an age-related event in a population with Less Births / Prolonged Survival

When cure is not a reality Suspecting the cancer Suspicions confirmed Staging the cancer Advanced stage Opinion re chemotherapy Personal and family reactions Hope vs reality Chemotherapy

Objectives PERSON: Live longer Quality of Life Dignity STATE: Cost-effectiveness Standards of care MEDICAL STAFF: Maintain quality of life Minimise toxicity Prolong survival Progression-free survival Minimise disease- related toxicity Balance between all the various factors

Palliative Chemotherapy Other patients / families (the waiting room) Anti-cancer agents Support personnel: –oncologists, nurses, physios, OTs, dieticians, social workers, psycho-oncology, palliative care team, health care assistants, ward clerks, catering staff, cleaners, etc The Hospital building The Internet’s message of hope / options The Myths History / transmitted memories

3 Lives -:- 3 Pathways Relatively asymptomatic Symptomatic, but reversible Profoundly symptomatic, non-reversible

Considerations re Treatment Performance Status Range of agents Therapeutic target Measuring benefit –Symptoms –Radiology –Function When to break / stop

Survival curve percentiles and their corresponding scenarios. Kiely B E et al. JCO 2011;29: ©2011 by American Society of Clinical Oncology

Selected Toxicities Erlotinib and Docetaxel (indirect retrospective contrast)

Emerging Targets: NSCLC, adenoca.

Metastatic: NSCLC, 1 st line Histology / Molecular profile –EML4-ALK mutation (7% of adenocarinoma) –EGFR mutation (17% of adenocarcinoma) –K-ras (22% of adenocarcinoma) StudyAgentsRRPFS (mos) LUX LUNG 3 Cisplat-Pem Afatinib 22% 56% (13.6) IPASS Carbo-Pac Gefitinib 41% 71% EURTAC Cis/Doc or Gem Erlotinib 15% 58%

Lux Lung 3: common mutations

Toxicity Profile Afatinib vs Cis/Pem Grade 3/4 Toxicity (%) Grade 3/4 Toxicity (%) Diarrhoea Rash/acne Stomatitis/mucositis Paronychia Nausea Fatigue Lux Lung 3

Ms. A.A Small cell Lives with partner, children abroad Nervous Extreme dyspnoea Haemoptysis

Nov. 13 th, 2012

Pre- and Post 4 cycles of chemotherapy

Post sequential chest radiation

8 months post diagnosis 5 months post completion of chemotherapy

Ms. M.C. Breast lesion x 4yrs Single; no children Bleeding chest wall; increasing left arm pain, with decreasing sensation Deliberated over radiation and chemotherapy

Pre-Treatment

Progressive disease: Dx date +5 months

Further chemotherapy: Dx date +12 mths

Considerations The Person The Realistic outcomes Realistic optimism The person’s objectives Focus on Quality / Prolongation of life When not to treat Beyond treatment Those remaining

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