Survivorship Care for People Affected by Advanced or Metastatic Cancer: MASCC-ASCO Standards and Practice Recommendations

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Abstract

PURPOSE

People with advanced or metastatic cancer and their caregivers may have different care goals and face unique challenges compared with those with early-stage disease or those nearing the end of life. These Multinational Association for Supportive Care in Cancer (MASCC)-ASCO standards and practice recommendations seek to establish consistent provision of quality survivorship care for people affected by advanced or metastatic cancer.

METHODS

A MASCC-ASCO expert panel was formed. Standards and recommendations relevant to the provision of quality survivorship care for people affected by advanced or metastatic cancer were developed through conducting (1) a systematic review of unmet supportive care needs; (2) a scoping review of cancer survivorship, supportive care, and palliative care frameworks and guidelines; and (3) an international modified Delphi consensus process.

RESULTS

A systematic review involving 81 studies and a scoping review of 17 guidelines and frameworks informed the initial standards and recommendations. Subsequently, 77 experts (including eight people with lived experience) across 33 countries (33% were low- to middle-resource countries) participated in the Delphi study and achieved ≥94.8% agreement for seven standards, (1) Person-Centered Care; (2) Coordinated and Integrated Care; (3) Evidence-Based and Comprehensive Care; (4) Evaluated and Communicated Care; (5) Accessible and Equitable Care; (6) Sustainable and Resourced Care; and (7) Research and Data-Driven Care, and ≥84.2% agreement across 45 practice recommendations.

CONCLUSION

Standards of survivorship care for people affected by advanced or metastatic cancer are provided. These MASCC-ASCO standards support optimization of health outcomes and care experiences by providing guidance to stakeholders (health care professionals, leaders, and administrators; governments and health ministries; policymakers; advocacy agencies; cancer survivors and caregivers). Practice recommendations may be used to facilitate future research, practice, policy, and advocacy efforts. Additional information is available at www.mascc.org , www.asco.org/standards and www.asco.org/survivorship-guidelines .

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Most cited references 105

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Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update

Betty Ferrell, Jennifer Temel, Sarah Temin … (2017)

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Redefining Palliative Care—A New Consensus-Based Definition

Lukas Radbruch, Liliana De Lima, Felicia Marie Knaul … (2020)

Context. The International Association for Hospice and Palliative Care developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health-related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief. Objective. The main objective of this article is to present the research behind the new definition. Methods. The three-phased consensus process involved health care workers from countries in all income levels. In Phase 1, 38 PC experts evaluated the components of the World Health Organization definition and suggested new/revised ones. In Phase 2, 412 International Association for Hospice and Palliative Care members in 88 countries expressed their level of agreement with the suggested components. In Phase 3, using results from Phase 2, the expert panel developed the definition. Results. The consensus-based definition is as follows: Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers. The definition includes a number of bullet points with additional details as well as recommendations for governments to reduce barriers to PC. Conclusion. Participants had significantly different perceptions and interpretations of PC. The greatest challenge faced by the core group was trying to find a middle ground between those who think that PC is the relief of all suffering and those who believe that PC describes the care of those with a very limited remaining life span.

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Integration of oncology and palliative care: a Lancet Oncology Commission

Stein Kaasa, Jon H Loge, Matti Aapro … (2018)

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care.

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Author and article information

Contributors

Nicolas H. Hart: (View ORCID Profile)

Larissa Nekhlyudov: (View ORCID Profile)

Thomas J. Smith: (View ORCID Profile)

Jasmine Yee: (View ORCID Profile)

Margaret I. Fitch: (View ORCID Profile)

Gregory B. Crawford: (View ORCID Profile)

Bogda Koczwara: (View ORCID Profile)

Fredrick D. Ashbury: (View ORCID Profile)

Maryam B. Lustberg: (View ORCID Profile)

Michelle Mollica: (View ORCID Profile)

Andrea L. Smith: (View ORCID Profile)

Michael Jefford: (View ORCID Profile)

Fumiko Chino: (View ORCID Profile)

Robin Zon: (View ORCID Profile)

Meera R. Agar: (View ORCID Profile)

Raymond J. Chan: (View ORCID Profile)

Journal

Title: JCO Oncology Practice

Abbreviated Title: JCO Oncol Pract

Publisher: American Society of Clinical Oncology (ASCO)

ISSN (Print): 2688-1527

ISSN (Electronic): 2688-1535

Publication date (Electronic): April 29 2024

Affiliations

[1 ]Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia

[2 ]Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia

[3 ]Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia

[4 ]Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia

[5 ]Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia

[6 ]Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

[7 ]Division of General Internal Medicine and Sidney Kimmel Comprehensive Cancer Center, John Hopkins Medical Institutions, Baltimore, MD

[8 ]Centre for Medical Psychology and Evidence-Based Decision-Making, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

[9 ]School of Graduate Studies, Faculty of Nursing, University of Toronto, Toronto, ON, Canada

[10 ]Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia

[11 ]Northern Adelaide Local Health Network, Adelaide, SA, Australia

[12 ]Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

[13 ]Flinders Cancer and Innovation Centre, Flinders Medical Centre, Adelaide, SA, Australia

[14 ]VieCure, Clinical and Scientific Division, Greenwood Village, CO

[15 ]Department of Oncology, University of Calgary, Calgary, ON, Canada

[16 ]Department of Medicine, School of Medicine, Yale University, New Haven, CT

[17 ]Medical Oncology Division, Yale Cancer Centre, New Haven, CT

[18 ]Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD

[19 ]The Daffodil Centre and University of Sydney: a joint venture with Cancer Council NSW, Sydney, NSW, Australia

[20 ]Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

[21 ]Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

[22 ]Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY

[23 ]Michiana Hematology-Oncology, Mishawaka, IN

[24 ]Cincinnati Cancer Advisors, Norwood, OH

[25 ]IMPACCT Research Centre, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia

Article

DOI: 10.1200/OP.23.00716

SO-VID: 0d870b81-bb5d-4082-850a-8c8e718d14d7

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Survivorship Care for People Affected by Advanced or Metastatic Cancer: MASCC-ASCO Standards and Practice Recommendations

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Abstract

PURPOSE

METHODS

RESULTS

CONCLUSION

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Citation Behaviour and Practice

Most cited references 105

Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update

Redefining Palliative Care—A New Consensus-Based Definition

Integration of oncology and palliative care: a Lancet Oncology Commission

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