The value of proper and optimal palliative and supportive care in GU cancers
Led by esteemed Chairs Prof. Silke Gillessen Sommer (CH) and Dr. Maria Carmen Mir Maresma (ES), the Plenary Session “Challenges in supportive care in GU cancers” provided vital information in bolstering palliative and supportive care in patients with genitourinary (GU) cancers. This article highlights some of the updates shared during the session.
In the state-of-the-art lecture “Optimising supportive care for metastatic GU cancers”, Dr. Florian Scotté (FR) cited the findings of the National Cancer Database retrospective study “Considerations for palliative care in urologic oncology” by Bryn Launer, et al. The study showed supportive care is infrequent for patients with advanced urologic malignancies, and barriers to accessing supportive care included the following:
- Misconceptions about the definition of palliative care
- Limited access to the healthcare system
- Physician factors (i.e. lack of awareness concerning the value of global/multidisciplinary care)
- Patients’ acceptance
One of the solutions that Dr. Scotté discussed was derived from the paper “Integration of oncology and palliative care: A Lancet Oncology Commission” by Stein Kaasa, et al. wherein two approaches were combined: tumour-directed approach (focus on treating the disease) and host-directed approach (focus on the patient). This combination will result in a systematic assessment, improvement in patient-reported outcomes, and active patient involvement in the decisions. As a consequence, there will be better symptom control, improved physical and mental health, and better use of healthcare resources.
He also cited the position paper on supportive and palliative care by ESMO (European Society for Medical Oncology) which stated, ”Supportive and palliative care interventions should be integrated, dynamic, personalised, and based on best evidence. They should start at the time of diagnosis and continue through to end-of-life or survivorship.”
Dr. Scotté concluded his lecture with the apt quote by Prof. Dorothy M.K. Keefe, past president of MASCC (Multinational Association Of Supportive Care In Cancer): “Supportive care makes excellent cancer care possible.”
During the Society of Urologic Oncology (SUO) lecture “Palliative treatment for wound healing problems in penile cancer surgery”, Dr. Philippe Spiess (US) underscored the importance of recognising adverse prognosis attributable to locally advanced/advanced penile cancer and tailoring discussions with patients and their families accordingly. He added that there is a significant under-utilisation of palliative and supportive care in the management of advanced disease.
Dr. Spiess also discussed the benefits of using penile punch biopsies for easy procurement of tissue samples, as well as wound vacuum-assisted closure (VAC), which he referred to as “game-changing”, especially for patients who have complex wounds or undergone previous radiation treatment, for after major resections, etc. He cited a retrospective study published in the European Urology journal which evaluated the use of the wound VAC in the management of complex wound failures following prior ILND (inguinal lymph node dissection) for penile cancer. The study concluded that wound VAC helps stimulate a faster healing process.
Dr. Spiess brought his presentation to a close with the message “One cannot emphasise the benefits attributable to caring for the patients at tertiary care centres by a dedicated multidisciplinary team that addresses all of the needs, which include the psychosocial impact on patients and their families.”
The Plenary Session concluded with the bestowal of the SUO Recognition Award to Dr. Spiess.
To (re)watch the full presentations during this Plenary Session, please visit EAU On Demand on the Virtual Platform.