Palliative Care, Pain Management and Rehabilitation

The Complex Unit for Palliative Care, Pain Management and Rehabilitation at the IRCCS National Cancer Institute Foundation in Milan (INT) is a national and international centre of excellence for pain management and palliative care in advanced-stage cancer, as well as for the rehabilitation of cancer patients at all stages of the disease, from diagnosis to recovery.  

The mission of this Unit, through its Palliative Care and Pain Management division – which forms a fundamental part of it – is to address the needs of patients at all stages of the disease, with the aim of improving quality of life and offering a system of care and support integrated with the diagnostic and therapeutic pathway for every type of cancer

The palliative care services are delivered across various settings: Outpatient Clinic, Day Hospital and Home Care, Inpatient Care in the Palliative Care Unit (Hospice) and In-house Consultancy. The management of pain and other symptoms of the disease is the unit’s primary therapeutic objective.  

The range of care services, which operate in close proximity to one another and in synergy with the cancer treatment facilities, enables comprehensive care throughout the entire course of the illness for those who choose the Cancer Institute as their centre of care.

The Virginio Floriani Hospice has a capacity of 10 beds, dedicated to palliative care for patients in the advanced stages of illness, particularly cancer, where home care is no longer feasible. All beds have been accredited for use.

The Home Palliative Care Unit supports care pathways within the ATS Città di Milano area for patients with advanced chronic illnesses and a poor prognosis, with particular focus on patients treated at the Cancer Institute.

The facility also offers patients the opportunity to participate in clinical trials evaluating innovative analgesic therapies.

The patient’s quality of life is at the heart of the clinical approach and is considered in terms of the relief of physical, psychological, social and spiritual symptoms. For this reason, the facility’s philosophy is based on teamwork involving various professions and disciplines: doctors, nurses, psychologists, spiritual counsellors, rehabilitation therapists and complementary therapies. Patient care is provided in constant collaboration with the oncology departments and specialists, with the utmost attention paid to communication, respect for the patient’s autonomy and their family context.

Volunteer support also plays a defined and significant role in this process. 
Attention to the patient’s preferences includes facilitating their choices, for example regarding the most appropriate place of care. Care is tailored to the patient’s needs with the aim of facilitating and supporting the positive aspects of each individual clinical history through specific and targeted interventions, including support for the family.

Oncological rehabilitation provides care through a wide range of interventions addressing both post-surgical outcomes and chronic effects – of treatments and the disease itself – in both adults and children. Particular attention is also paid to the complexity of the disease in its advanced stages through integrated functional and physical therapies.

Rehabilitation treatments are provided both to inpatients following a request from the ward doctor and after a physiatric consultation, and to outpatients.

The first appointment for an outpatient consultation is made following a referral issued by a General Practitioner or by the doctor at the Institute’s general outpatient clinic, marked ‘initial physiatric consultation’. For follow-up appointments, access to the clinic is granted following the completion of a referral form by the rehabilitation clinic doctor, marked “Follow-up physiatric consultation”. 
Access to rehabilitation treatments is also permitted for patients from other facilities provided they have a rehabilitation plan and the relevant referral.

Candidates for outpatient treatment involving manual and/or physical therapies include all those who have undergone surgery, or who have received radiotherapy or chemotherapy for various oncological conditions, and who present with sequelae relevant to physiatry. 

TYPES OF TREATMENT

• Lymphoedema (primary and secondary): treatments may be prescribed using compression therapy or manual lymphatic drainage in combination with multi-layer compression bandaging, or ten-head ultrasound and/or lymphatic taping. These therapies are often combined with manual therapy, and a prescription is given for an elastic support garment. 
• Post-operative outcomes following thoracic and abdominal surgery and in cases of chronic respiratory conditions (COPD, bronchiectasis, asthma, smoking cessation): exercises aimed at improving respiratory performance and exercise retraining may be prescribed, including the use of incentive devices. 
• Dysphagia (swallowing disorder) resulting from surgical outcomes and sequelae of radiotherapy to the cervical/facial region: postural adjustments and dietary strategies may be prescribed to restore functional swallowing. 
• Traumatic sequelae, skin lesions, inflammatory and degenerative arthropathies: physical therapies such as laser, ultrasound, TENS, electrostimulation, magnetotherapy, shockwave therapy and TECAR may be provided. These have both analgesic and therapeutic aims, activating reparative and anti-inflammatory processes and accelerating recovery times. 
• Urinary incontinence: specific physical therapies may be provided, aimed at improving the tone and elasticity of the perineal muscles and urinary continence.
• Bone metastases: physical therapy, exercise therapy and training in the use of orthopaedic aids may be prescribed to complement multimodal oncological and palliative care. 
• Paediatrics and adolescents: rehabilitation treatments include exercise therapy, psychomotor therapy, postural therapy and respiratory therapy, depending on the specific issues and the patient’s age. Patients are cared for both as inpatients and outpatients throughout the various stages of cancer: at diagnosis, following surgery, during cancer treatments and in the terminal phase. Our Department is also responsible for prescribing aids and orthoses. 

This is how we, as a specialist unit, contribute to making the Institute an oncology centre that considers the patient, rather than the disease, to be the true focus of care.