**2. Palliative care**

Palliative care has appropriately been receiving increased attention in recent years, due to better comprehension of this field of action and due to incremental costs of antineoplastic therapy disproportionated with clinical results.

From practical standpoint, therapy is considered palliative when resection of all known tumor sites is no longer possible or advisable and chemotherapy have limited benefit rate. Since a cure, as commonly defined, is not possible, the goal of treatment and eventually the success of therapy become judged by the control of symptoms and alleviation of suffering, not more by survival advantages or longer disease-free intervals [10].

Providing optimal palliative care for the patient with advanced colorectal cancer is a complex and challenging process. The success rate depends on proactive multidisciplinary interventions, taken early in metastatic disease [11].

Palliative care can improve all phases of the disease, it allows better decisions in the end-of-life care and potentially reduces health-care expenditures, but the exact understanding of commonly used terms such as "supportive care," "symptom control" "palliative care," and "hospice care" was rarely and inconsistently defined in the palliative oncology literature [12].

The roots of palliative medicine may be traced since Hippocrates through medieval medicine until a more recent approach of Cicely Saunders and to a new concept of modern palliative care. It has evolved from a philosophy of care for the dying to an interprofessional discipline that addresses mainly the quality of life for patients and their families throughout the disease trajectory [13].

The best palliative care will ever require a multidisciplinary approach where treatment plans will be made in accordance with the wishes of the patient and his family with a goal of decreasing morbidity and focus on improving quality of life by addressing their physical, emotional, and spiritual needs, and on supporting their families [14].

The provision of optimal palliative care for these patients is a compound and demanding process and becomes more challenging when an incurable and asymptomatic primary progress to advanced metastatic colorectal disease [15].

Surgical resection may provide good palliation of symptoms and prevent future tumor-related complications as we saw before [15].

Better than dividing patients into strict treatment protocols and different models of care, this new concept supports the provision of patient care by a single discipline comprised of a team of health-care professionals with expertise in symptom management, psychosocial care, spiritual support, caregiver care, communication, complex decision-making skills, and end-of-life care [16].

The need for incorporating palliative care into routine oncology practice is still enormous, but the benefits of doing so are even more significant. Outside United States and some places in Europe, financially strained health systems will need costeffective models of palliative care delivery. As the aging population increases, the

**207**

*Palliative Care in Colorectal Cancer*

oncology care.

cases [9].

*DOI: http://dx.doi.org/10.5772/intechopen.93513*

raising the need for this kind of approach.

palliative care delivery will be required.

**3. Symptoms of advanced disease**

chemotherapy (adjuvant or for metastatic disease).

palliative surgery may be the most appropriate approach.

is limited, endoscopy has a crucial role in palliation [22].

radiotherapy, laser therapy and other transanal procedures [12].

multidisciplinary approach is essential [19].

or internal by-pass or a stenting [21].

number of people diagnosed with cancer, and degenerative disease will increase,

Volunteer work fills a large part of these gaps and can be the way out to overcome difficulties in access and funding [17], but adequate training of volunteers is

Community involvement needs to go beyond resource mobilization. In the current context of health systems, reaching higher levels of participation, involving the community as a partner in the implementation and support of these projects is something more complex and more difficult to achieve. Common barriers include the lack of mandatory preparatory work to understand the community's social and

Public expectations will rise and require that expectations will rise and require

that palliative care be well integrated into all oncology care settings. All these factors will serve to promote the integration of expectations of a new way of

control, no psycho-emotional measures can be adequately developed.

The most important goals of palliative care are stablishing a good communication and offer an outstanding symptom control. Without adequate symptom

Initial symptoms vary from mild anemia to bowel obstruction. In extremis, two main situations are considered, asymptomatic (or minimally symptomatic) and severely symptomatic patients needing aggressive management, including emergency

For a significantly part of symptoms or complications, the main treatment approach is surgery, by resection of the primitive tumor or stoma, eventually resection of liver metastasis, combined with radiotherapy (for rectal cancer) and

Beyond surgery, the management of metastatic disease has significantly changed over the last three decades with the incorporation of antiangiogenics (bevacizumab and panitumumab) and anti EGFR1 agent (cetuximab), and more recently, immunomodulation with anti-PD1 and Anti PD-L1 agents. Nowadays the

Emergency management of colorectal cancer patients still represents a major issue and is associated to high morbidity/mortality, and where there was often no time for patient directives to be established. The two major situations are obstruction and massive bleeding. Perforation is a rare presentation [20]. For these situations,

Obstruction is traditionally approached surgically by colonic resection, stoma,

Perforation is associated with the highest mortality and remains mostly matter for surgeons, by abdominal lavage/drainage, colonic resection and/or stoma [11]. In cases of more advanced disease, patients may present with jaundice (due to liver metastasis or biliary tract obstruction) or malignant ascites. As the number of patients with malignant distal biliary obstruction who will undergo curative surgery

Bleeding may be managed by surgery or less invasive approaches, including

essential to obtain the appropriate level of performance [16].

political dynamics, the facilitators' values and agenda [18].

As we see in the United States, as the cancer population grows, an already limited oncology workforce will be further strained. Cost- and resource-effective models of

### *Palliative Care in Colorectal Cancer DOI: http://dx.doi.org/10.5772/intechopen.93513*

*Colorectal Cancer*

**2. Palliative care**

disease-free intervals [10].

in the palliative oncology literature [12].

their families throughout the disease trajectory [13].

tumor-related complications as we saw before [15].

decision-making skills, and end-of-life care [16].

selected for reading and synthesis of this work.

Today, the median overall survival for patients with metastatic colorectal cancer being treated both in phase III trials and in large observational series or registries is about 30 months and is more than double that of 20 years ago [9]. These patients with unresectable disease remain incurable and the treatments are mainly palliative. We performed a non-systematic literature review of the results of a search in PubMed® with terms "palliative care" and "colorectal cancer" published in the last 5 years without restrictions of language. We found 304 articles that were manually

Palliative care has appropriately been receiving increased attention in recent years, due to better comprehension of this field of action and due to incremental

From practical standpoint, therapy is considered palliative when resection of all known tumor sites is no longer possible or advisable and chemotherapy have limited benefit rate. Since a cure, as commonly defined, is not possible, the goal of treatment and eventually the success of therapy become judged by the control of symptoms and alleviation of suffering, not more by survival advantages or longer

Providing optimal palliative care for the patient with advanced colorectal cancer is a complex and challenging process. The success rate depends on proactive multi-

The roots of palliative medicine may be traced since Hippocrates through medieval medicine until a more recent approach of Cicely Saunders and to a new concept of modern palliative care. It has evolved from a philosophy of care for the dying to an interprofessional discipline that addresses mainly the quality of life for patients and

The best palliative care will ever require a multidisciplinary approach where treatment plans will be made in accordance with the wishes of the patient and his family with a goal of decreasing morbidity and focus on improving quality of life by addressing their physical, emotional, and spiritual needs, and on supporting their

The provision of optimal palliative care for these patients is a compound and demanding process and becomes more challenging when an incurable and asymp-

Surgical resection may provide good palliation of symptoms and prevent future

Better than dividing patients into strict treatment protocols and different models of care, this new concept supports the provision of patient care by a single discipline comprised of a team of health-care professionals with expertise in symptom management, psychosocial care, spiritual support, caregiver care, communication, complex

The need for incorporating palliative care into routine oncology practice is still enormous, but the benefits of doing so are even more significant. Outside United States and some places in Europe, financially strained health systems will need costeffective models of palliative care delivery. As the aging population increases, the

tomatic primary progress to advanced metastatic colorectal disease [15].

Palliative care can improve all phases of the disease, it allows better decisions in the end-of-life care and potentially reduces health-care expenditures, but the exact understanding of commonly used terms such as "supportive care," "symptom control" "palliative care," and "hospice care" was rarely and inconsistently defined

costs of antineoplastic therapy disproportionated with clinical results.

disciplinary interventions, taken early in metastatic disease [11].

**206**

families [14].

number of people diagnosed with cancer, and degenerative disease will increase, raising the need for this kind of approach.

As we see in the United States, as the cancer population grows, an already limited oncology workforce will be further strained. Cost- and resource-effective models of palliative care delivery will be required.

Volunteer work fills a large part of these gaps and can be the way out to overcome difficulties in access and funding [17], but adequate training of volunteers is essential to obtain the appropriate level of performance [16].

Community involvement needs to go beyond resource mobilization. In the current context of health systems, reaching higher levels of participation, involving the community as a partner in the implementation and support of these projects is something more complex and more difficult to achieve. Common barriers include the lack of mandatory preparatory work to understand the community's social and political dynamics, the facilitators' values and agenda [18].

Public expectations will rise and require that expectations will rise and require that palliative care be well integrated into all oncology care settings. All these factors will serve to promote the integration of expectations of a new way of oncology care.

The most important goals of palliative care are stablishing a good communication and offer an outstanding symptom control. Without adequate symptom control, no psycho-emotional measures can be adequately developed.
