Palliative and End of Life Care
- Patients with incurable disease undergoing palliative treatment such
as chemotherapy or immunotherapy should be treated when significant
extension of life (>6 months) and reduction of symptoms
are reasonable expectations. Consideration should be given to
alterations in treatment plans to reduce number and frequency of
visits, including reduced frequency of imaging to re-assess disease if
the state of disease can be assessed by other means.
- Consider a 4-6-week schedule for pembrolizumab for those patients who
are clinically and radiographically stable or responding after 3-6
months of immunotherapy
- Consider discontinuation of immunotherapy for patients that are well
into a complete response beyond one year.
- End of life patients should receive necessary care, much or all of
which can be delivered at home via telehealth visits. Palliative care
consultations at Penn Medicine are now being done entirely via
telehealth visits. Goals of care (serious illness) conversations
should occur early on to facilitate this approach.23