Optimal Cancer Care: Concurrent Oncology and Palliative Care

Optimal cancer care requires the integration of palliative care into practice. This concept has been endorsed by widely respected organizations, including the WHO, the Institute of Medicine (IOM), the European Society of Medical Oncology (ESMO), and ASCO. With the aging of the population, the associated increase in the incidence of cancer, and the growing number of patients living with complications of cancer and its treatment, palliative care is more important than ever. Despite strong recommendations and growing clinical data supporting the benefits of concurrent palliative care and cancer care, resistance continues. Why is this? What are the barriers and, more importantly, what are the solutions? A group of international experts met in Rome, Italy, to review the current status of concurrent palliative and oncology care in different countries and to address these questions. This supplement is a product of these discussions. The group focused on the following key issues in the integration of palliative care into cancer care: development of a standard definition of palliative care and its component parts; models for care delivery; standardization of tools for patient assessment; educational programs designed to meet the needs of health care professionals; and the importance of developing best practices in symptom management using breakthrough pain management as an example (see article by Von Roenn et al in this supplement). Palliative care is an essential component of excellent cancer care. All patients and families deserve patient-specific information about their illness, its treatment, and natural history. All patients should expect cutting-edge cancer treatment in the context of their personal goals, with attention to their physical, psychological, social, spiritual, and practical concerns. This type of care is best provided by an interdisciplinary team focused on the relief of suffering in all of its dimensions. Although this view is widely accepted, the group identified continued confusion about the definition of palliative care (see article by Glare in this supplement). In different parts of the world, the term palliative care refers to care at the end of life only, and in others, to patient- and family-centered care across the trajectory of illness, regardless of prognosis. The differences in definition are primarily ones of timing (when in the course of illness the care is provided) as opposed to differences in the components of excellent palliative care. The term supportive care, rather than palliative care, has been suggested as an alternative name because it might be less distressful to patients, families, and health care professionals. However, I suspect the distress is based on the widespread misconception (at least in the United States) that referral to palliative care means that the patient is dying. If supportive care replaced the term palliative care, the former would take on the same meaning unless we work to educate the public about the benefits of this care, no matter what we label it. Results of a recently completed project of the Center to Advance Palliative Care (CAPC) support this contention and suggested language that might reduce this distress. 1 In collaboration with the American Cancer Society, the CAPC commissioned a study to explore the awareness and understanding of palliative care by consumers and policymakers and to test language, terminology, definitions, and messaging that might be better used in discussions of palliative care with the public. While evaluating American consumers, the researchers discovered that the term palliative care had little or no meaning to most patients, there was a general lack of awareness that palliative care services exist, and physicians tended to equate palliative care with end-of-life