American Society of Clinical Oncology Statement: Toward Individualized Care for Patients With Advanced Cancer
American Society of Clinical Oncology Statement: Toward Individualized Care for Patients With Advanced Cancer
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DOI：
10.1200/jco.2010.33.1744
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发表时间：
2011-02-20
影响因子：
45.3
通讯作者：
Schnipper, Lowell E.
中科院分区：
文献类型：
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作者：
Peppercorn, Jeffrey M.;Smith, Thomas J.;Schnipper, Lowell E.
晚期无法治愈的癌症患者面临着疾病及其治疗带来的复杂的身体、心理、社会和精神后果。对这些患者的护理应包括对患者在整个病程中的需求、目标和偏好进行个性化评估。考虑针对疾病的治疗、症状管理和对生活质量的关注是优质癌症护理的重要方面。然而，新出现的证据表明，关于预后、疾病导向治疗的潜在益处和局限性以及姑息治疗的潜在作用（无论是与疾病导向治疗结合使用还是作为疾病导向治疗的替代疗法）的现实对话往往发生在病程后期或根本不发生。本文阐述了美国临床肿瘤学会 (ASCO) 改善与晚期癌症患者的沟通和决策的愿景。该声明提倡采用个体化方法，在整个护理过程中为晚期癌症患者讨论并提供针对疾病的支持性护理选择。基于 ASCO 之前关于临终关怀 (1998) 和姑息治疗 (2009) 的声明，本文回顾了在讨论患者的个人目标和护理偏好时改善晚期癌症患者护理的证据。它概述了个体化护理的目标、目前限制实现这一愿景的障碍，以及克服这些障碍的可能策略，以改善与患者目标和循证医疗实践相一致的护理。
Patients with advanced incurable cancer face complex physical, psychological, social, and spiritual consequences of disease and its treatment. Care for these patients should include an individualized assessment of the patient's needs, goals, and preferences throughout the course of illness. Consideration of disease-directed therapy, symptom management, and attention to quality of life are important aspects of quality cancer care. However, emerging evidence suggests that, too often, realistic conversations about prognosis, the potential benefits and limitations of disease-directed therapy, and the potential role of palliative care, either in conjunction with or as an alternative to disease-directed therapy, occur late in the course of illness or not at all. This article addresses the American Society of Clinical Oncology's (ASCO's) vision for improved communication with and decision making for patients with advanced cancer. This statement advocates an individualized approach to discussing and providing disease-directed and supportive care options for patients with advanced cancer throughout the continuum of care. Building on ASCO's prior statements on end-of-life care (1998) and palliative care (2009), this article reviews the evidence for improved patient care in advanced cancer when patients' individual goals and preferences for care are discussed. It outlines the goals for individualized care, barriers that currently limit realization of this vision, and possible strategies to overcome these barriers that can improve care consistent with the goals of our patients and evidence-based medical practice.