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ASQO approach

Through a mnemonic system (from A to Z) a list of actions is included in ASQO approach.

Pain control is dynamic and continuous. Pain medication can cause adverse events and should be treated.

Respiratory symptoms are very commom in the terminal phase of disease and need to be treated to bring comfort to patients and family. Check digestive system as a cause of cough, as long as neurologic impairment (aspiration). Treatment toxicity can cause cough when lung inflammation is present.

Haemodynamic status should be checked to prevent hypotension due to dehydration. Oedema can be present as a consequence of immobilization, anemia or/and malnutrition. Hypertension can also be a complication of treatment.

Anorexia is frequent and wheight loss can translate into caquexia. Nutrition supervion by a professional is part of oncologic treatment. Meals should be small and frequent.

Patients and their families need information to actively participate in the decision-making process. For example, they need to learn how to deal with lifge threatening complications, such as neutropenic fever (infection complication when immune system is impaired due to chemotherapy).

Gynecologists are necessary to garantee fertility preservation as well as to treat menopausal symptoms wich can be antecipated by ovarian failure due to chemotherapy.

The goals of treatment (cure, symptom control) should be discussed with patients and their families allowing them to participate in this dynamic decision-making process. Quit smoking shoul also be discussed taking into account that tabagism compromise treatment efficacy.

Humor symptoms, such as depression, anxiety, and sleep disturbances are commom and should be treated as soon as diagnosed in an attempt to incease quality of life.

Uncommom sites of infection, such as genitalia, skin, nails, scalp, pelvic/perineum, oral cavity, have more importance in immunocompromised patients and shoul be checked.

Physical activity can ameliorate treatment-related asthenia and should be offered to patients receiving chemotherapy. Loss of lean mass (sarcopenia) should be treated to decrease dependency and risk of fall. Another collorary is the lower incidence of diabetes and cancer diagnosis and recurrence.

Objective assessment of performance (clinical conditions) should be done to identify those patients for whom treatment should be delayed or stopped.

Listening patiently enables rapport establishment wich can translate into higher treatment adherence.

Prescription reviews avoid complications due to misuse and increase compliance.

Permissive prescription of antiemetics, specially for those highly emetogenic chemotherapy regimens, should be done, since this adverse event can compromise food acceptance.

Trials are testing the impact of dose reductions (tailoring) in older and frail metastatic patients in an attempt to increase tolerance without compromising efficacy.

Early patients preferences information should be collected in terms of hospice enrollment, cardiopulmonary resuscitation, sedation, and local of death.

Questions and concerns
All the questions and concerns should be answered prompt and in a clear manner.

Patients should be included in clinical trials (clinical research) to garantee quality of life preservation.

Chemotherapy can cause reemergence of underlying deseases, such as hepatitis B and should be searched. Diabetes is associated with increased risk of cancer development and should also be searched and treated.

Close monitoring of early and late toxicities avoid life threatening compliactions.

Unfold family history for genetic testing and counseling.

Involvement of volunteers, including cancer survivors, is a useful and can help patients with costs and support.

Weekends/chemo holidays
Predefined treatment holidays in metastatic patients can be scheduled permitting them to travel and meet relatives.

A multidisciplinary team working in combination is necessary to deliver all this support.

Yoga, meditation, songs, movies, massage, acupuncture are now included in intregative medicine, such as ASQO support.

The last letter in the alphabet was used to remeber that all cancer patients are very important people (VIP).

Adapted from:
Temel et al, 2010 NEJM
Jacobsen et al, 2011 J Palliat Med
The Quality Oncology Practice Initiative

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