English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

With April 1991 heralding in what are arguably the most major changes ever in the NHS, palliative care services, as with all other aspects of health care, are being 'provided' and 'purchased', against the background of defined service specifications ('business plans') and agreed 'contracts'. Such terminology would, just 5 years ago, have been unheard of or even thought heretical, by clinical carers in this often emotive and 'public spirited' field. Such attitudes were heightened by the tendency of health care professionals to arbitrarily separate off 'palliative' care from general cancer treatment services; palliative care took over after the failure of or absence of specific oncological treatment. Such a situation could not be to the benefit of patients; whilst researching the underlying causes and possible curative treatments is a fundamental role for oncologists, it is not true that they are 'just interested in finding a cure for cancer; a foolhardy and costly exercise which diverts them and resources from more cost effective areas'. Indeed more than half of their work load is concerned with the relief of symptoms by radiotherapy and/ or chemotherapy. Neither are palliative care physicians motivated only by a wish to help their patients die comfortably! The term continuing care is sometimes used to encompass the multidisciplinary aspects of cancer management from diagnosis to cure or palliation or to death, and this is a useful concept in the overview of cancer care services as a whole. Part of the role of oncologists affiliated to District General hIospitals must be to provide an on-site specialist service potentially accessible to all patients at any stage of their illness (Rees et al., 1991). The benefits of cancer treatment are longer survival, relief of symptoms or both. Treatment may be unpleasant and costs must be taken into account (Rees, 1985; Markman, 1988). Potentially curative and adjuvant therapies, if assessed as cost for each year of benefit obtained, are good value for money generally less than £1000 per year per patient (Rees, 1991). For example, taking into account all costs (chemotherapy, radiotherapy, hospital care, investigations etc) the average patient-benefit-year cost in advanced Hodgkin's Disease is approximately £450 and for adjuvant CMF (Cyclophosphamide, Methotrexate, Fluorouracil) in localised breast cancer £400. Active palliative treatments, which are often relatively more expensive than 'best supportive care', need to be effective but must also use resources appropriately (Rubens, 1990) long courses of radiotherapy or high cost or prolonged chemotherapy regimens (which are not part of an evaluated trial), particularly in-patient, usually achieve no better results than shorter, less expensive treatments (e.g. Price et al., 1986; Spiro & Souhami, 1990). As a specific example a recent MRC prospective randomised trial showed that a two-treatment radiotherapy regimen was as safe, tolerable and effective as a more prolonged (10 fraction) treatment in palliating symptoms (MRC Lung Cancer Working Party, 1991). Resources may be better used in increasing consultation time and multidisciplinary care. Hower, eco-

Quality and cost in the palliative care of cancer