This document provides an overview of a webinar on goals of care when cancer is chronic. It introduces the speakers, Dr. Jim Cleary and Reese Garcia. It provides information on how to ask questions during the webinar and access webinar archives. The document also includes a disclaimer and biographies of the speakers. Finally, it outlines some of the topics that will be covered in the webinar, including palliative vs curative intentions, informed consent, maintaining hope, and adjusting goals of care over time.

1. Goals of Care When Cancer Is Chronic

2. TODAY’S WEBINAR
 SPEAKER(S)
 Dr. Jim Cleary, MD from University of Wisconsin Cabbone
Cancer Center and Fight CRC’s Reese Garcia
 QUESTIONS
 Ask a question in the panel on the RIGHT SIDE of your
screen
 WEBINAR ARCHIVE
 FightCRC.org/webinar
 TWEET ALONG
 Follow along via Twitter – use the hashtag #CRCWebinar

3. RESOURCES
TABOO-TY PODCAST MINI MAGAZINES YOUR GUIDE IN THE FIGHT

4. FIGHTCOLORECTALCANCERDISCLAIMER
The information and services provided
by Fight Colorectal Cancer are for
general informational purposes only.
The information and services are not
intended to be substitutes for
professional medical advice,
diagnoses or treatment.
If you are ill, or suspect that you are ill,
see a doctor immediately. In an
emergency, call 911 or go to the
nearest emergency room.
Fight Colorectal Cancer never
recommends or endorses any specific
physicians, products or treatments for
any condition.

5. Dr.JimCleary,MD
ProfessorofMedicine(MedOnc&
PalliativeCare
James Cleary, MD, is Associate Professor of Medicine, Medical
Oncology Section; Director of Palliative Medicine at UW Hospital
and Clinics; and Academic Medical Director of Agrace for Dane
County. After receiving his medical degree from the University of
Adelaide Medical School, South Australia, Dr. Cleary completed his
Internal Medicine Residency and Oncology fellowship at the Royal
Adelaide Hospital and three years of research in opioid
pharmacology at the University of Adelaide.
He is an international leader in Palliative Medicine and is a board
member and past president of the American Academy of Hospice
and Palliative Medicine. He is a Master Facilitator for the
Education of Physicians in End-of-Life Care Program (EPEC).
He had led training sessions over six years, educating more than
1,000 physicians throughout the U.S. He serves as North American
Editor of Palliative Medicine, the Research Journal of the European
Association of Palliative Care.

6. Goals of Care
When Cancer Is Chronic
Jim Cleary MD
Professor of Medicine (Med Onc & Palliative Care)
University of Wisconsin Carbone Cancer Center

7. • No potential associations/conflicts of interest.
• Re-establish goals of therapy in cancer care
• Explore issues of informed consent.
• Explore Hope……
• “Patient Communication: Balancing Hope Versus Reality”

11. What are we doing in Medicine?
What are we doing
in Cancer Medicine?

12. Palliative
vs
Curative
Intentions of Treatment

13. Survival Curve
Normal Population
Disease
%
survival
Years

14. The scope of the problem…
"Why should we continue to spend billions of dollars a year on a health care industry whose sole purpose
is to prevent death, only to find, once again, that death awaits us all?"
http://www.theonion.com/content/news/world_death_rate_holding_steady_at

15. Cure
Normal Population
Cure
Disease
%
survival
Years

17. Prolongation of Survival
Normal Population
Cure
Disease Prolongation
of survival
%
survival
Years

18. Palliation
Normal Population
Disease
%
survival
Years

26. Improving Palliative Care for Cancer, 2001
• Communication
• Advanced Care Planning
• Symptoms from Disease
• Symptoms from Therapy
• Psychosocial Issues
• Care of Imminently Dying
http://www.nap.edu/books/0309074029/html/

27. Palliative Care: Definition (CAPC)
• Comprehensive multidisciplinary management of
patients’ needs: - physical - psychological
- social - spiritual
- existential.
• Part of the treatment of any person with a serious or life-
threatening medical condition for which we need:
- patient-centered approach
- pain and symptom control
- family involvement
- compassionate care.
• Synonymous with good medical/nursing care, involving all
health care team members.

28. Physical
Spiritual
Social
Existential
Psychological
What is
Palliative
Care?

29. Improving Palliative Care for Cancer, 2001
• Communication
• Advanced Care Planning
• Symptoms from Disease
• Symptoms from Therapy
• Psychosocial Issues
• Care of the Imminently Dying
http://www.nap.edu/books/0309074029/html/

37. Words
• “Nothing”
• “No treatment”
• “Failed” therapy
• “Salvage Therapy”
• I would be “happy” to care for you
• Talking “to” patients
• “Refused”
• Hope

39. Truth Telling
“If you tell the truth,
you don’t have to remember
what you said.”

40. Informed consent
• Informed consent is the process by which the treating
health care provider discloses appropriate information
to a competent patient so that the patient may make a
voluntary choice to accept or refuse treatment.
• The nature of the decision/procedure
• Reasonable alternatives to the proposed intervention
• The relevant risks, benefits, and uncertainties related to
each alternative
• Assessment of patient understanding
• The acceptance of the intervention by the patient

41. How much information is adequate?
• Reasonable physician standard: what would a
typical physician say about this intervention?
• Reasonable patient standard: what would the
average patient need to know in order to be an
informed participant in the decision?
• Subjective standard: what would this particular
patient need to know and understand in order to
make an informed decision?

42. Palliative
vs
Curative
Intentions of Treatment

44. “Hope promised
that she would help
them endure the
suffering that was
now inescapable.
Thus, hope--so
essential to the
human spirit--is
inextricably
connected to
suffering. “

46. “focused hope” provides indispensable
support to patients yearning for cure or relief
from disease.
However, this kind of hope can only be
maintained by concentrating on outward,
tangible goals such as cure or recovery.
Like any of the worldly objects on which its
existence depends, focused hope may be
gained or lost. It has a dark side: if
overextended, it can prevent patients from
facing their own mortality, denying them
valuable opportunities for shared decision
making and fully-informed consent for

47. “intrinsic hope” lies buried in the human psyche.
It is an inborn trait that all humans share.
Although it may lie dormant, hidden under
layers of strongly held emotion or denial, it can
emerge unexpectedly after longed-for outcomes
fail to materialize and focused hope fades. [5]
As opposed to outer-directed focused hope,
intrinsic hope centers on subjective, personal
issues. For example, patients may hope not to be
a burden, or to give and receive love in
relationships with family and friends.

48. Wendy Harpham
• REALISTIC HOPE VERSUS WISHFUL THINKING
• The lure of alternative therapy was powerful but I knew that not all
hope is equal. Realistic hope—hope based on fact—is stronger than
that born of wishful thinking, which is why my desire for a sense of
control over my disease was overshadowed by my resolve to learn the
facts about my treatment options and base my decision on them.
Professional discipline helped me keep my emotions from getting in
the way as I tried to review data on the risks and benefits of
alternative therapies. I wanted to make sure I would be comparing
apples against apples when looking at alternative versus conventional
options.

50. Hope
1. Trust, Reliance
2a. Desire accompanied by expectation of or belief in
fulfillmment
2b. Someone or something on which hopes are
centered
2c. Something hoped for.

51. Hope as an expectation?
• 2a. Desire accompanied by expectation of or belief in fulfillmment
• 2b. Someone or something on which hopes are centered
• 2c. Something hoped for.
• Difficulty practicing cancer care in this setting

52. Hope
• 1. Trust, Reliance
• Faith and dependence
• Independent of outcome
• “hopeful” person trusts that whatever the outcome, good or bad
on first glance, will ultimately be for the best
• Religious faith
• Secular: faith in community

54. • “I found the cure for fear of
recurrence: Go ahead and have
one; then you'll stop worrying
about it!”
• Your patient is in remission.
You've done a great job.
(Seriously, bravo!) So celebrate,
and then prepare yourself—and
your patients—for the possibility
of post-treatment challenges
that keep you on your toes.

56. • Cure is a continuum. The ultimate goal is not always getting
rid of the cancer forever, but healing the patient in front of
us with expert and compassionate care.
• Everyone benefits if we remember our roots and see “a cure”
as part of our broader mission: “to care.”

57. Hope does not lie in a way out,
But in a way through.
Robert Frost

58. Modern Model
Traditional Care
Palliative Care Hospice
Death6-Month
PrognosisDiagnosis
Focus
of
Care
Time 
Symptom
Burden
Campbell TC et al Semin Intervent Radiol 2007

59. Q
&
A
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$25,000).
Flex a “strong arm” & post it to Twitter or Instagram using the
hashtag #StrongArmSelfie

60. CONTACT US
CALL TOLL FREE
1.877.427.2111
FightCRC.org