Zusammenfassung
Fortschritte in der onkologischen Therapie von nicht heilbaren Tumorpatienten machen
die Einschätzung einer korrekten Prognose schwieriger. Mittels molekularer Marker
unterteilen sich die diversen Tumorerkrankungen in immer kleinere Subgruppen mit unterschiedlichen
Prognosen. Eine Vorstellung im interdisziplinären Tumorboard sollte Standard sein.
Um übersteigerte und unrealistische Erwartungen am Lebensende zu minimieren, bedarf
es optimaler Aufklärung und der Integration einer frühen palliativen Betreuung in
den weiteren Behandlungsverlauf.
Abstract
One third of oncological treatment costs per patient is allocated to the last phase
of life. In the era of molecular oncology and immuno-oncology, patients benefit from
new treatment options inducing durable and long-lasting responses. However, it becomes
more difficult to estimate the prognosis of oncology patients. The treatment indication
is based on the evidence from randomized controlled studies. In contrast, the decision,
when to stop treatment at the end of life and provide best supportive care, is an
emerging and challenging situation in routine clinical care of oncologists and palliative
care teams. Up to 50% of oncology patients receive chemotherapy within the last 4
weeks before death, thus it becomes evident to stop futile treatment. Reliable biomarkers
to predict the response of immunotherapy are lacking for most of solid tumors. Several
palliative prognostic scores have been validated to calculate the probability of survival
in the next 30 – 60 days. Unfortunately, there is no consensus on which score should
be preferred and none was validated in period of immuno-oncology. The estimation of
expectation of life by an interdisciplinary medical team is recommended by the German
guideline of palliative medicine. Of note, treating physicians often overestimate
the prognosis of patients, and shared decision making whether to start, to continue
or to stop therapy for the individual patient remains difficult. Early integration
of palliative medicine and advance care planning focus on the patientʼs medical perspective.
Clinical trials investigating the 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. Changes at the system
level are necessary for implementation of advance care planning to improve the quality
of the end of life of oncology patients.
Schlüsselwörter
Palliativpatienten - Onkologie - nicht heilbare Tumorerkrankung - Aufklärung - Überlebenswahrscheinlichkeit
- Immuntherapie - Chemotherapie
Key words
palliative patients - oncology - immunooncology - prognosis - immunotherapy - end
of treatment
