WORKSHOP 1

Introduction to Palliative Care: Learning How to Use the Elevator Speech
Dr. Rojim J. Sorrosa

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. (WHO)

Explaining the principles of palliative care to our patients and our colleagues is a big challenge. The Elevator Speech is a concise way of presenting ideas, concepts, principles designed to make the person understand in the shortest possible time.

WORKSHOP 2

Critical Conversations in Palliative Care:
Advanced Care Planning
Dr. Djhoanna Aguirre-Pedro

Advance Care Planning (ACP) is the process of discussing and planning future health care that a patient wants to receive in the context of anticipated deterioration of health. It should be voluntary. The discussion and planning should take place early in the course of the terminal illness, preferably when the patient is still competent to participate in the care planning, but can happen at any time. The decision is based on the patient’s beliefs, values, culture, preferences of care, wishes, current and anticipated medical status and treatment options. The advance care plan is a flexible document and not a single event. It is an on-going process, therefore, is open to change, revisions and even cancellations. It is not only limited to medical issues, but may include spiritual and interpersonal issues as well.

WORKSHOP 3

Terminal and Bereavement Care
Dr. Arabelle Coleen P. Ofina

Terminal phase of a patient’s illness journey is a challenging time for patients, families and the health
care team since there is increased prevalence of concerns in all aspects – physical, psychosocial and existential. There is a need for managing the whole person with the goal of still ensuring the quality of life by effective symptom control and supportive care. Families are assisted during this phase – allowing them to understand the illness course and its treatment since this will affect their later adjustment. Continuity of care does not end when cure is no longer offered, but extends into bereavement.

WORKSHOP 4

Wound Care
Dr. Kathrina Angeles

Pressure sores, fungating or ulcerating malignant masses or wounds from injury are some of the conditions that are encountered among patients with life threatening illnesses. Complicated factors such as ineffective skin integrity, delayed healing from metabolic problems, poor nutrition and cognition, and immobilization make wound care challenging. Practical knowledge and skills should be acquired to do good wound care as this promotes comfort and dignity for the patient and reduces the level of distress for the family.

PLENARY 1

Palliative Care in the National Integrated
Cancer Control Act of the Philippines
Dr. Rumalie A. Corvera

As an idea whose time has finally come, the integration of Palliative and Hospice Care (PHC) into the National Integrated Cancer Care Act (RA 11215) has spelled out hope for those facing cancer. We finally see movement in answer to the challenge posed by a headline in 2015 siting the low ranking of the Philippines in the provision of PHC, based on an Economist Intelligence Unit report. This was largely attributed to the lack of government-led strategy for the development and promotion of national palliative care. Four years later, Philippine legislators clearly defined the role of Palliative and Hospice Care in cancer care in Republic Act 11215, which was finally passed on February 14, 2019. Well outlined in declaration of policy of this law, “The State shall endeavor to prevent and control cancer and improved cancer survivorship by scaling up essential programs and increasing investments for risk assessment...optimal treatment, surveillance, responsive palliative care and pain management, effective survivorship care and late effects management, rehabilitation and hospice care.” As we learn more about the implementing rules and regulations of RA 11215, understand its provisions and the processes involved in making it operational, we will also see the importance of mobilizing not just the health care system, but also the role
of community empowerment in the delivery of palliative and hospice care.

SESSION 1 A

Palliative Care as a Basic Human Rights
Dr. Joanna Michelle Sabal

Palliative care is a holistic approach in improving quality of life of patients and their families hence it is essential in maintaining health and human dignity. It is a fundamental human right. With the trend of increasing age of life expectancy and prevalence of noncommunicable diseases, the need for palliative care is predicted to rise. However, not everyone that supposedly requires palliative care are able to access it at this time. When palliative services are available, the patient is relieved from suffering pain or other stressful symptoms, psychological and spiritual issues are addressed, the quality of life and in turn the course of illness may be improved, pathologic bereavement is prevented and dignity is preserved. The challenge now is how to incorporate palliative care in every country’s policies and how to implement these.

SESSION 1B

Management of Radiotherapy-Related Toxicities
Dr. Maria Fidelis C. Manalo

Nearly two thirds of patients with cancer will undergo radiation therapy as part of their treatment plan. Given the increased use of radiation therapy and the growing number of cancer survivors, palliative care workers will increasingly care for patients experiencing adverse effects of radiation. Although early radiation toxicities are usually part of the subspecialist’s care, patients with late effects often present to the family physician. The lecture will be about the early and late adverse effects from radiation therapy and how they can be managed to improve the quality of life of cancer patients.

SESSION 2A

Palliative Care Approach for Mucositis,
Anorexia-Cachexia, and Nausea-Vomiting
Dr. Agnes Bausa-Claudio

Mucositis, anorexia cachexia and nausea and vomiting are complex syndrome which are often defined
in terms of its primary or secondary causes. Primary causes are related to metabolic and neuroendocrine changes directly associated with underlying disease and an ongoing inflammatory state. Secondary causes are aggravating factors that contribute to weight loss. These common symptoms in the terminal stages of an illness aside from pain, fatigue, constipation, delirium and dyspnea are physical symptoms that often contribute to suffering near the end of life. Recognition, proper evaluation, assessment, dietary and symptom management, patient education is important. Most significantly when do you timely refer to palliative care? Timely referral to palliative care specialist service minimizes the patient’s and caregiver’s distress, ensures better quality of life and appropriate measures at the end of life care. In this talk we will discuss all these aspects of care surrounding these common palliative symptoms.

SESSION 2B

Pediatric Oncology:
Changing Goals from Cure to Care
Dr. Mae Concepcio-Dolendo

The goal of oncologists does not only include reducing tumor burden and increasing survival rate but also maintaining good quality of life. Since the provision of cancer care encompasses preventive education, screening and diagnostic evaluation, communication of details of disease, treatment, psychosocial support
and end of life care, the role of an oncologist is very challenging. A multidisciplinary approach to care, wherein the health care providers of different disciplines and the ancillary services work as a team to manage the patient, lead to better health and quality of life outcomes, efficient use of resources and satisfaction for patients, their families and the health care team.

SESSION 3A

Palliative Care Approach: Pain Management
Dr. Rachael Rosario

Pain is defined by the International Association for the Study of Pain IASP as an ‘unpleasant, sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. It is purely subjective and affects daily activities, sleep and interaction – influencing negatively the quality of life. Several assessment tools and treatment strategies are available however undertreated pain is still common. Proper history taking of details of the complaint will allow us to understand the pathophysiology of the pain and lead us to the proper management including pharmacologic and nonpharmacologic interventions and timely referrals.and dignity is preserved. The challenge now is how to incorporate palliative care in every country’s policies and how to implement these.

SESSION 3B

Palliative Sedation
Dr. Rojim J. Sorrosa

Palliative sedation is a measure used to relieve severe and refractory symptoms. It is performed by the administration of sedative medications in monitored settings, and is aimed at inducing a state of decreased awareness. Sedatives can be given intermittently or continuously, through a subcutaneous or an intravenous route in a variety of clinical settings, determining different levels of sedation (mild or deep) to achieve adequate symptom relief.

SESSION 4A

Palliative Care Approach for the Elderly with Cancer
Dr. Barbara Amity Flores

Advancements and improvements in healthcare have contributed to individuals living longer. This increase in life expectancy poses challenges in the care of the older person who accumulate multiple chronic, complex medical problems that require close supervision, as well as develop age-related frailty and functional dependency through time. Cognitive decline that also increases with age, is an additional ordeal for the elderly unable to communicate their own healthcare preferences, and for the family who will have to take on the burden of difficult decision-making in their behalf. Palliative care plays an important role in providing specialized, comprehensive, multidimensional, and coordinated care geared towards the provision of best quality of life for this special vulnerable group and their families.

SESSION 4B

Clinical Nutrition - Challenges in the Terminal Phase
Dr. Grace Manuales

One of the causes of distress of the terminally ill patient is not being able to eat properly probably due to taste changes, loss of appetite as effect of disease process, dysphagia and other pathologies affecting the gastrointestinal tract. It is also a source of concern of the family since feeding is a major expression of care. Poor nutrition is usually perceived to be associated with weight loss, fatigue and poor functional status. The challenge for the health care providers is understanding the complexity of the disease and its metabolic sequelae that lead to the signs and symptoms earlier mentioned so we can optimize nutritional support and guide patients and families in terms of care.

SESSION 5A

Palliative Care Approach for Children with Cancer
Dr. Martha Umali

Palliative Care in the context of a child with cancer is the total care for the child and the family all throughout the stages of illness from diagnosis to cure or bereavement. It is addressing needs of the physical, psychological, social and spiritual aspects to maintain quality of life. It is important to have a separate discussion on palliative care for children for us to know the proper approach especially that children have age-appropriate cognition and psychological responses to events including illnesses.

SESSION 5B

Palliative Care Sensitization in Training Programs
Dr. Suresh Kumar

With the number of deaths from communicable and non- communicable diseases and the number of older people with chronic or advanced disease, palliative care is in demand however underutilized. Movement of palliative care globally has to be improved. Some awareness strategies are to incorporate education on palliative care in schools of different disciplines (medicine, nursing, nutrition, psychology and social work), and in training programs in various hospitals and communities.