Thank you for the opportunity for me to just share a little bit about palliative care and the delivery of palliative care and introduction to it for our Shenzhen fellows and I'll make it brief. And I'm Dr. Brian Li, the Palliative Care Unit Associate Consultant in Grantham Hospital, as well as Queen Mary Hospital. So I think, first of all, nowadays with the new treatments, options nowadays with immunotherapy, targeted therapy, a lot of chemotherapy advances, a lot of the patients in gynecology, they actually survive longer. But when it comes to metastatic stage four diseases, eventually they will have resistance, and they have recurrence and end-of-life is still a very important topic. And so what matters to people when they approach end-of-life? I think there are quite a lot of things, including being involved in the decision-making process, being comfortable, free of symptoms, well-controlled symptoms, and they need to be recognizing that there is like this impending death and there's a sense of closure to the loved ones and family, affirmation of their values, trust for the care providers, optimizing relationship with family and friends, and a death in a preferred place, and religions, spirituality, and leaving a legacy. And we see sufferings. And the way we see sufferings and pain is through, you know, a very kind of like a total sense. So I think when we say palliative care, we have to reference to Dr. Saunders, who's a pioneer in the UK, starting at the St. Christopher Hospice many, many years ago. And, you know, suffering is the kind of thing that encompasses all of the person's physical, psychological, social, and spiritual elements. So that's why the WHO definition of palliative care embraces this concept. So palliative care is basically an approach that improves the quality of life patients and their families, you know, when they're facing life-threatening illnesses. In gynaeco-oncology patients, they are facing cancers, and to relieve the sufferings in all of these aspects that I mentioned. And over the years, actually, palliative care evolved from, you know, just terminal care in the hospice, taking care of patients in only the last few days or a knife, into, you know, this more broader concept of end-of-life care, when a patient is facing a definite, you know, downhill course in their disease trajectories. And then it further expands to the modern concepts of palliative care, which it's applied a lot earlier on during the cancer trajectories of patients, a way to support the patients, you know, symptom management, focusing on quality of life, you know, collaborating with the oncological teams and other lung cancer organ specialist teams. So the whole concept is basically a lot broader than just the hospice or terminal care. And that's the way Hong Kong is doing. So I think the key palliative care values and principles would be very broad, but they can be broadly summarized into, you know, these few areas. Like the first one is obviously optimizing quality of life and promoting dignity and autonomy. And we also pay attention to caregivers, you know, and also we are applying this to the whole disease trajectory from early on in the metastatic cancer stage to the very end of life and after death, we provide bereavement for the families. And it's definitely a multi-professional approach. So we have a multidisciplinary teams, doctors, nurses, chaplains, allied health, physio, occupational therapy. And we are nowadays, we are also paying more and more attention in the advanced care planning and advanced directives, supporting patients' decision-making process during the disease trajectories. So specifically for cancers, I think most important is we do symptom control. We use, you know, we can use strong opioids for the very severe cancer pains. And we have a lot different pharmacological and non-pharmacological means. And we support the patients during the anti-cancer therapy. We have communication and over the disease course. So that's why the new concept of palliative care now is basically, we applied it very early on in the disease and our role is getting more and more during the deterioration of the patient's trajectory. And then in the very end, we may provide hospice care for them. And then we provide bereavement after the patient's death. So I think our collaboration with the Greenberry Gynae Oncology team has evolved. And I would think we are now in a more integrated care model. It's like we do joint runs every week and we take care of some patients in joint clinics. Communication is very close. We can refer patients back and forth. The patient can even see both of the oncology team and palliative care teams together or in the same sections side by side if they have needs. So it's a very integrated model. And then we do specific concepts for specific reasons. Say if you want endoscopic stenting, then we find the surgeons. If we need some specific, you know, analgesic procedures, we can find the anesthetist pain teams. And first, complicated psychiatric issues, we can find psychiatrists. Whereas in the past, when we were not as established, we may do just very isolated and models. And that's probably not as ideal. So I think for the Shenzhen Hospital fellows, I think from my experience, we cannot refer every patient for palliative care specialists. So I think it's very good because over the years, we work very closely with the Greenberry Gynae specialists. We actually have, you know, we can actually stratify the patient according to their needs. So there are like this general palliative care approach that any doctors, not just oncologists, but any doctors should have the basic skills, you know, to pay attention to symptoms and quality of life patient. And then when it comes to oncologists, there's a lot of skills they have acquired in talking about prognosis, explaining advanced care planning, pain controls. And when there's like specific problems, then we can always refer to specialists, like various use of a very complicated, strong opioids, very difficult cycle, social difficulties, issues, then we are there to receive the consults. And nowadays, the advanced care planning and advanced directives is getting more and more in Hong Kong, but probably is not as common in mainland China yet. So basically, the concept is we try to explain to patient when they are deteriorating, and plan ahead of what is actually important to them in the end of life, including, you know, the treatment plans, important decision makings, especially about life-sustaining treatments. And if they are mentally competent, and they understand well, they can sign advanced directive refusing futile life-sustaining treatments towards the end of life. So I think, lastly, I would like to share a few important clinical trials on the benefits of early positive care in the application of, you know, cancer patients' treatments. So one of them is from New England, the other is from Lancet and JAMA. So I think the most important one would be the one published in 2010 in the New England Journal of Medicine, where a group of cancer patients, they are randomized, they are actually non-sponsored lung cancer patients, they are randomized into receiving early palliative care versus standard oncology care, about 150 of them. And in that particular trials, it actually showed improved quality of life in the intervention group, slightly lower depression scores, and actually a slightly longer survival of patients receiving early palliative care. So it sort of clears the misconception that if you refer patients for palliative care, you're actually giving up the patients. But in contrast, you're not actually reducing the survival of patients, maybe slightly adding a little bit of survival. And subsequently in Lancet, a similar trial was published. This time, it's actually a cluster randomization trials in 24 oncology clinics. This one didn't show a significant change in the quality of life scores, but there is a, and there is actually a significant difference in the subset of the quality of life favoring the PC group. And subsequently in the Journal of Clinical Oncology, another similar trial also showing a lower depression score for the caregivers. And although the survival is probably similar between the groups. So I think in summary, I think I've tried to explain what palliative care is and its relationship with cancer care. And so basically there is quite a bit of evidence showing, you know, benefits of early integration of palliative care in the oncology, you know, care settings. And the models that we are providing palliative care in Queen Mary Hospital, Guiding Oncology Patients is kind of the integration model. We integrate a lot and we work quite a long time. And I think that's a very effective model. If in the Shenzhen and China, if they have, you know, further development, I think this would be a good way forward. Thank you. Well, thank you, Brian, for your

palliative care

life-threatening illnesses

gynaecology

end-of-life care

quality of life