Table 1.

When and why to consider primary or secondary palliative care for patients with advanced ACC.

Palliative Care in ACC Patients: When?
Both these criteria Patients with advanced disease (stage IV) and/or requiring chemotherapy Indications from the NeCPal ICO Tool and surprise question
Further criteria for secondary palliative care (at least one) Limited performance status (ECOG> = 3; KPS <= 50) Superior vena cava syndrome Medullary compression Hepatic and/or renal insufficiency Effusions of neoplastic origin Severe physical, psychiatric, psychosocial or substance-abuse comorbidities Refractory pain Delirium, major depression, cachexia Other uncontrolled symptoms Severe distress related to cancer diagnosis and/or therapy Spiritual crisis and/or suicidal ideation, attempts or requests Difficulty communicating with the patient and/or his/her family Care-planning support needs
Palliative Care in ACC Patients: Why?
Complex symptom management ▪Treatment of refractory symptoms (e.g., pain, depression, dyspnea, nausea), regardless of endocrine secretion control ▪Complex treatments of pain and other bothering symptoms (e.g., opioid rotation, parenteral analgesics therapies, drug infusions) ▪Help in dealing with complex situations of psychological, spiritual and/or existential suffering ▪Palliative sedation for otherwise intractable symptoms
Global management of complex patients ▪Support for loss of mobility and increased assistance needs (home and residential hospice care) ▪Multiprofessional and multidisciplinary program of care case-management coordination
Help in difficult decision-making processes and/or in defining treatment goals ▪Communication and awareness improvements ▪Definition of care goals ▪Discussion in moments of “transition” of care (e.g., futile treatments, surgical interventions that do not lead to an improvement in the quality of life) ▪ Management of conflicts relating to methods used for treatment objectives: ○ Within the family ○ Between families and a care team ○ Among different care teams ▪Redefinition of “hope” in clinically and ethically complex situations ▪Sharing of decision making and advanced care planning for the end-of-life stages