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Frühzeitige spezialisierte palliativmedizinische Mitbehandlung

Ein herausfordernder Goldstandard

Early specialized palliative care

A challenging gold standard

  • Palliativmedizin und Supportivtherapie
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Zunehmende Evidenz belegt die Möglichkeit, durch strukturierte und frühzeitige Integration der spezialisierten Palliativmedizin die Versorgung von Patienten mit Krebserkrankungen in nichtkurativer Therapiesituation zu verbessern.

Ziel

Es soll ein aktueller Überblick zum Thema „Frühe Integration der spezialisierten Palliativmedizin bei Patienten mit Krebserkrankungen“ vermittelt werden.

Material und Methode

Es erfolgte eine selektive Literaturrecherche und Darstellung des aktuellen Wissenstands und neuer Entwicklungen.

Ergebnisse

Zahlreiche Studien zur Ergänzung der onkologischen Behandlung durch die Mitbehandlung bzw. Beratung durch Teams der spezialisierten Palliativmedizin sind in früher palliativer Behandlungssituation durchgeführt worden. Eine Verbesserung zeigte sich u. a. in folgenden Bereichen: bessere Lebensqualität, weniger depressive Symptome, längere Zeit zwischen letzter Chemotherapie und Tod, weniger Chemotherapie in den letzten 60 Lebenstagen, weniger Notaufnahmen, häufigere hospizliche Mitbetreuung, besseres Krankheitsverständnis und verlängertes Überleben. Die Versorgungsstrukturen in Deutschland sind für diese meist ambulant geleistete frühzeitige spezialisierte Palliativversorgung nicht eingestellt. Die spezialisierte ambulante Palliativversorgung beschränkt sich bisher auf die Betreuung in häuslicher oder stationär-pflegerischer Umgebung und die letzten Lebenstage, -wochen oder -monate.

Schlussfolgerungen

Die Evidenz für eine frühzeitige spezialisierte palliative Mitbetreuung von Krebspatienten gut und die Schaffung der hierfür notwendigen Versorgungsstrukturen eine wichtige zukünftige Aufgabe.

Abstract

Background

Increasing evidence demonstrates an improvement in the quality of care of patients when specialist palliative care services are integrated into the care of cancer patients at an early stage.

Aim

This article provides an up to date review on early integration concepts of specialist palliative care for cancer patients.

Material and methods

A selective search of the literature was performed, the currently available evidence is reported and suggestions regarding future developments are being provided.

Results

Many studies have investigated the benefits for cancer patients when specialist palliative care is provided at an early stage in the course of the disease in addition to active oncological treatment. The data demonstrate an improvement in the following areas: improved quality of life, less depressive symptoms, longer time periods between last chemotherapy and death, less chemotherapy within the last 60 days of life, less admissions to emergency units, higher rates of hospice care, improved understanding of the disease and prognosis, and prolonged survival. In Germany, the current structures of medical care are not prepared to so as to provide specialized palliative care in an outpatient setting (SAPV). Current SAPV structures provide home care predominantly in the last days, weeks or months of life.

Conclusion

The evidence for early integration of specialist palliative care into the treatment of cancer patients is high but the implementation of feasible and effective structures of care remains a future task.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Gärtner, U. Wedding und B. Alt-Epping geben an, dass kein Interessenkonflikt besteht.

Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Palliativmedizin, Universitätsklinikum Freiburg, Robert-Koch Str. 3, 79106, Freiburg, Deutschland

    J. Gärtner

  2. Abteilung für Palliativmedizin, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland

    U. Wedding

  3. Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland

    B. Alt-Epping

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  1. J. Gärtner
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Correspondence to J. Gärtner.

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Gärtner, J., Wedding, U. & Alt-Epping, B. Frühzeitige spezialisierte palliativmedizinische Mitbehandlung. Onkologe 21, 1182–1188 (2015). https://doi.org/10.1007/s00761-015-3072-4

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  • DOI: https://doi.org/10.1007/s00761-015-3072-4

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