While advances in cancer therapy hold promise for arresting disease progression, science and research development has targeted the physical, psychosocial, and existential elements of living with advanced cancer.
Even with recognition of, and recommendations for, addressing supportive care needs of patients with advanced cancer, an inequality in comprehensive cancer care persists for this vulnerable population due to several factors: lack of trained professionals to undertake research and clinical care, difficulty to guide the delivery and dissemination of supportive care services, and limited funding for developing and testing interventions to alleviate symptoms.
To overcome this critical gap in cancer care, one fresh approach is the early integration of palliative care (PC) services with standard oncology care soon after a patient's diagnosis of advanced cancer.
Normally, a multidisciplinary team of physicians, nurses, social workers, and chaplains deliver PC services, which focus on symptom management, psychosocial support, and assistance with treatment decision-making for patients with serious illnesses, their families, and their other health care providers.
In recent years, researchers have begun testing the feasibility and efﬁcacy of innovative models of PC delivered simultaneously with oncology care in the ambulatory care setting.
Persistent misconceptions regarding the role of PC providers and the goals of such treatment complicate the integration of these services into other medical practices. Many oncologists tend to refer patients to specialized PC services only for uncontrolled symptoms or late in the course of disease when planning discharge.
Clinicians are well suited to ﬁll this critical role in comprehensive cancer care given their training in managing medical symptoms, delivering psychosocial and spiritual support, assisting with complex treatment decisions, and working as part of a team and with other clinical specialists. Lastly, PC clinicians consider the family as the unit of care, providing counseling, education, and support to caregivers.
Recently published randomized controlled trials have offered the best evidence to date regarding the efﬁcacy of early PC interventions delivered concurrently with oncology care for patients with advanced cancer. Introducing PC services soon after diagnosis for patients with advanced cancer helps to enhance quality of life, reduce depression, improve the quality of care at the end of life, and possibly prolong survival — the delivery of integrated PC and oncology care services throughout the course of advanced cancer improves multiple outcomes for patients and families.
Further research is needed to elucidate the mechanisms by which PC interventions lead to these effects, as well as to adapt and apply novel models of early PC in the full range of care settings (home, ofﬁce, cancer center, nursing home, and hospital).
See reference for more information, and to see the pain management algorithm for the critically ill patients at the end of life.
Adapted from Meier D. Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA: A Cancer Journal for Clinicians, 2013. Internet. Accessed on January 22, 2020.