Contribution of Collegial Support Meetings (CSM) in the management of complex situations of patients with advanced cancer

Abstract

Abstract Purpose Collegial Support Meetings (CSM) have been set up in the Gustave Roussy Cancer hospital for inpatients whose complex care requires a multi-professional approachinvolving participants from various fields. CSMs are composed not only of oncologists but also of health-caregivers, a member of the palliative care team, an intensivist and a psychologist. This study aims to describe the role of a newly implemented CSM in a French Comprehensive Cancer Center. Methods Each week, the health-caregivers decide the situations to be examined, depending on the difficulty of a clinical case and/or the occurrence of specific events. The discussion goes on to include the goal of treatment, grading the level of care, ethical and psychosocial issues, and the patient's life plan. The patient’s wishes are carefully considered. Finally, to obtain feedback from the teams, a survey has been distributed to the health-caregivers to assess the interest in the CSM. Results In 2020, 114 inpatients were involved: 84 patients were metastatic and had received a median of 2 lines of treatment. Their general condition was deteriorated: 50% of patients were entirely dependent on care. During the CSMs, 55% of the discussions focused on whether to continue specific cancer treatment - 29% were about whether to continue invasive medical care - 50% about optimizing supportive care. Forty patients (35%) died during the hospitalization. Conclusions CSM, an innovative approach in French oncology, places health-caregivers at the heart of the system and strives to reach consensual and consistent conclusions for all medical and nursing staff involved.