ReviewSupportive and palliative care for metastatic breast cancer: Resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement☆
Section snippets
Supportive and palliative care for metastatic breast cancer
Many women diagnosed with breast cancer in low- and middle-income countries (LMICs) present with advanced metastatic disease, or they may present with locally advanced disease and undergo treatment with curative intent but nonetheless develop metastases. Common sites for breast cancer metastases are bone, brain, liver, and lung; less common sites are intra-abdominal and skin. Cure is not usually a realistic treatment outcome for metastatic disease[1], but site-specific interventions (aimed at
Defining “supportive care” and “palliative care”
The terms “supportive care” and “palliative care” are sometimes used interchangeably[3]. However, supportive care in cancer is the prevention and management of the adverse effects of cancer and its treatment. This includes management of physical and psychological symptoms and side-effects across the continuum of the cancer experience from diagnosis through anticancer treatment to post-treatment care. Enhancing rehabilitation, secondary cancer prevention, survivorship and end-of-life care are
Existing evidence and guidelines
Evidence-based breast cancer clinical guidelines for treatment of metastatic breast cancer from international organizations[6], high-income countries (HICs)[7], [8] and LMICs[9], [10], all recommend supportive/palliative care as part of metastatic breast cancer care. These guidelines expand the concept of palliative care, previously limited to end-of-life care, to include supportive care offered concurrently with curative or life-prolonging treatments for patients with all stages of cancer.
BHGI Global Summit and expert panel consensus process
All three BHGI supportive care consensus statements provide recommendations for breast cancer supportive care program implementation in LMICs. Methods developed by the BHGI for the structured creation of evidence-based, 4-tier resource-stratified guidelines and consensus statements (see Table 1) have been previously described[21], [22]. A systematic literature review was performed in preparation for the 5th BHGI Global Summit, which was held in association with the International Atomic Energy
Key resources needed for supportive care with metastatic disease
The expert international panel identified thirteen key resource recommendations for supportive and palliative care for metastatic breast cancer. The recommendations are presented in three sections 1) health systems resource allocations; 2) resource allocation for organ-based metastatic disease management; and 3) resource allocations palliative care. In each section, a description of a resource category is followed by resource-stratified consensus panel recommendations. Recommendations are also
Special concerns and emerging issues in LMICs
Communication skills for end-of-life care: Effective communication between patients and health professionals has been associated with patient satisfaction with care at end-of-life[119]. However, many health professionals feel that they lack appropriate training to deal with end-of-life issues[120]. In that regard, many oncologists report the communicating of poor prognosis as one of the most challenging and stressful aspects of their profession[121]. Education about effective patient
Discussion
This consensus statement expands on the 2008 BHGI guidelines for resource-stratified treatment of site-specific metastases of breast cancer and palliative care[141]. Palliative care requires interdisciplinary care teams to address physical, psychosocial, and spiritual needs of breast cancer patients and their families. Interdisciplinary teams should include pharmacists, psychologists and psychiatrists, nurses, social workers and spiritual caregivers, with access to the services of
Panel members
Benjamin O. Anderson (BHGI Director, USA), Mohammad A. Bushnaq (Jordan), Rolando Camacho-Rodriguez (Summit Co-chair, Cuba), James Cleary (Co-chair, USA), Joe N. Clegg-Lamptey (Ghana), Stephen R. Connor (USA), Henry Ddungu (Co-chair, Uganda), Msemo B. Diwani (Tanzania), Alexandru Eniu (Romania), Margaret Fitch (USA), Julie R. Gralow (Summit Co-chair, USA), Sudhir Gupta (India), Joe B. Harford (USA), Suresh Kumar (India), Gertrude Nakigudde (Uganda), Mati N. Nejmi (Morocco), M.R. Rajagopal
Conflict of interest statement
BOA received consulting compensation from GE Healthcare and Navidea Biopharmaceuticals. JC received consulting/grant/research support from Procertus, grant/research support from Amgen, and was on the data safety and monitoring committee for KangLaiTe. MN received consulting support from Sanofi-Aventis. All other authors and panel members reported no potential conflict of interest.
Financial Acknowledgments
BHGI received (2012 Global Summit) grants and contributions from Fred Hutchinson Cancer Research Center, Susan G. Komen for the Cure® (Contract ID: INT-3063.0/Tracking No: 221664); International Atomic Energy Agency Programme of Action for Cancer Therapy, National Cancer Institute, The Lancet Oncology, Elsevier, American Society of Clinical Oncology, Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer, Pan American Health Organization, European Society of Medical Oncology,
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