The
EPEC-O
TM
Education in Palliative and End-of-life Care - Oncology
Project
The EPEC-O Curriculum is produced by the EPECTM Project with major funding
provided by NCI, with supplemental funding provided by the Lance Armstrong
Foundation.
E
P
E
C
O
EPEC - Oncology
Education in Palliative and End-of-life Care - Oncology
Plenary 2
Models of
Comprehensive
Care
Main message

Funding and service delivery
systems must be in place to provide
palliative care as a reliable
component of comprehensive
cancer care
Objectives

Comprehensive cancer care includes
palliative care from the day of diagnosis

Define hospice and palliative care and
relate their history

Describe funding and service delivery
models for providing comprehensive
cancer care

Understand when palliative care services
are appropriate for cancer patients
Video
Comprehensive cancer care

Gaps in contemporary cancer care

Approaches to relief of suffering
Piloted with hospice programs
More widely applied through palliative
care programs
Now being integrated into
comprehensive cancer care
Hospice

Historical evolution

Medicare Hospice Benefit
40% of dying cancer patients referred
Median enrollment 22 days
37% of patients die within 7 days
Conventional cancer care
Hospice in the US today

A place

An organization or program

An approach to or philosophy of care

A system of reimbursement
Hospice care
Hospice care

Safe and comfortable dying

Self-determined life closure

Effective grieving
Levels of care

Routine care

General inpatient care

Continuous care

Respite care
Core services

Interdisciplinary care
Chaplaincy, nursing, medical social services,
counseling, volunteers
Primary care physician
Palliative care physician (consultation)

Bereavement counseling

Medical equipment, supplies

Medications and therapies related to the
terminal diagnosis
Palliative care

Therapies to relieve suffering and
improve quality of life

May be combined with therapies
aimed at remitting or curing cancer,
or it may be the total focus of care
WHO 2002 definition of
palliative care
"Palliative care is an approach which
improves quality of life of patients
and their families facing lifethreatening illness, through the
prevention and relief of suffering by
means of early identification and
impeccable assessment and
treatment of pain and other
problems, physical, psychosocial
and spiritual"
Palliative care
Delivering palliative care
Primary
Secondary
Tertiary
Comprehensive cancer care

Anti-cancer therapy

Supportive care

End-of-life care

Bereavement care
Comprehensive cancer care
Clinical (secondary)
palliative care
Home
Consultation
Services
Inpatient
Care
SNF
Outpatient
Office
Case examples

Warren Grant Magnuson Clinical
Center, NIH, Bethesda

Memorial Sloan-Kettering, NYC

Dana-Farber Cancer Center, Boston

Fox Chase Cancer Center,
Philadelphia

MD Anderson Cancer Center,
Houston
Development as a specialty

Curricula

Certification exams

Journals

Textbooks

Fellowship training

Formal recognition as a subspecialty
E
P
E
C
Summary
O
Funding and service delivery
systems must be in place to
provide palliative care as a
reliable component of
comprehensive
cancer care