Early palliative care in cancer treatment: rationale, evidence and clinical implications

Abstract

Abstract:Patients with advanced cancer often experience symptoms of disease and treatment that contribute to distress and diminish their quality of life (QOL). Care that is aimed at control of these symptoms, whether or not the patient is undergoing ongoing disease-directed therapy to control the cancer, is thus a key feature of high-quality patient-centered care. In standard oncology practice, it is easy for focus on this type of care to be obscured by discussions and management of anticancer therapy and adequate attention to QOL, patient preferences, and goals of care often occur only days to weeks from the patient's death. The initiation of palliative care and discussion of the patients' goals and preferences earlier in the course of disease can lead to improved symptom control, reduced distress throughout the disease-directed therapy, and care delivery that matches the patients' preferences. This review discusses the evolving evidence for early initiation of palliative care in patients with advanced cancer and ongoing barriers to care in this setting. We highlight challenges for research and care delivery and the potential for broader awareness of the demonstrated benefits of palliative care to help translate known benefits into improved outcomes for patients facing advanced cancer.

Impact of aggressive management and palliative care on cancer costs in the final month of life

“…In the remaining analyses, the palliative designation continued to independently predict lower costs. This is in keeping with prior research demonstrating less intensive care and resource consumption when earlier palliative care is instituted . In randomized trials of patients with advanced cancer, patients allocated to earlier palliative care reported improved quality of life and were less likely to receive aggressive end‐of‐life care .…”

“…When physicians simply engage in end‐of‐life conversations, their patients experience less aggressive medical care near death (including fewer intensive care unit [ICU] admissions) with improved quality of life . With additional consultation with palliative care teams, further benefits in patient satisfaction and health care utilization have been demonstrated . As such, it would be anticipated that palliation could reduce the use of costly resources.…”

The Incidence of DNR Documentation in Patients Referred for Palliative Radiotherapy in the Rapid Response Radiotherapy Program

“…1 The concept of having a do-not-resuscitate (DNR) order aligns with the nature of palliative care, and is used to spare unnecessary trauma resulting from cardiopulmonary resuscitation (CPR) and extreme lifesaving measures. 2 It is encouraged to collect code status preferences at the time of admission to ensure clear documentation.…”

Palliative Care of Hematopoietic Cell Transplant Recipients and Families

“…10 Palliative care has been endorsed as a best practice in oncology by the American Society of Clinical Oncology and is incorporated into the clinical practice guidelines of the European Society for Medical Oncology and the Society for Surgical Oncology. 11 It is recommended that palliative care be delivered within the continuum of comprehensive cancer care, which would include care of individuals undergoing HCT.…”