Innovative palliative care for people with cancer : sustainable solutions for the future.
Date: 2024-10-29
Institutions: Directorate-General for Research and Innovation
Subjects: cancer, innovation, palliative care, social inequality, sustainable development, therapeutics

Innovative palliative care for people with cancer: 
sustainable solutions for the future 

Introduction 

The EU Cancer Mission aims to “improve the lives of more than 3 million people by 2030, through prevention, cure 
and  for  those  affected  by  cancer  including  their  families,  to  live  longer  and  better”,  by  breaking  barriers  and 
bringing innovative R&I approaches together with public health policies. Under its objective of quality of life, the 
Cancer Mission has launched several actions to improve the physical and mental health of patients with cancer 
and their families. 

This Policy Brief Document was developed in collaboration with researchers and experts on palliative care and 
through a series of workshops. It summarises the results of research projects, providing evidence on the value of 
palliative cancer care and ways of integrating it throughout the cancer care continuum while addressing inequity 
of access to it.  

Cancer affects millions of people across the European Union (EU) each year. In 2020 there were 2.7 million new 
cancer cases and 1.3 million deaths  from cancer in the  EU1.  Cancer is  the  number one cause of death for  EU 
citizens under 65, and the second most common cause of death for all EU citizens1 It exerts significant physical, 
emotional, and economic burdens with an estimated societal cost of cancer for the EU in 2018 of €199 billion1.

Care for people affected by cancer requires integrated support from families, social networks, health and social 
care services, and wider society.  
Support and care must be provided: 
- across the cancer care continuum, from prevention, detection, diagnosis, treatment, to survivorship, 
palliative care, and end-of-life care  
- across the life course, from prenatal and neonatal care, to children, adolescents and young adults (AYA), to 
adults of working age and to older adults. 

October 2024 

 
 
 
 
 
 
 
Palliative care is an approach that improves the quality of life (QoL) of adults and children and their families who 
are facing problems associated with life-threatening illness2.

Palliative care is essential, and is a core component of universal health coverage3. Palliative care is an important 
and powerful resource to improve experiences and outcomes across the cancer care continuum and across the 
life course. It is relevant from diagnosis and through treatment, and into bereavement, not only at the end-of-life 
stage. 

Palliative  care  is  delivered  by  multidisciplinary  teams  in  primary  care,  secondary  care,  and  tertiary  care,  by 
specialists and generalists, in all health and social care settings, by family carers and other informal carers, and 
by community networks. A public health approach to palliative care moves beyond individual clinical interventions 
to empower networks, community support, and society to address or prevent issues associated with life-limiting 
illness, dying, caring, and grieving.  

Figure: Components of palliative care, World Health Organization 
(creative commons licence) 

Recognising the need for innovative and sustainable palliative care, since 2008 the EU has funded 22 research 
and innovation projects, with a total budget of €110.9 million, to drive innovation in cancer palliative care for 
children, AYA, and adults. Drawing on evidence from these 22 EU funded projects and expert input, six challenges 
emerge as requiring urgent attention and action. 

1. Demonstrate and communicate the value of palliative care  

Palliative care improves QoL, reduces symptom burden4, and is cost effective5. Early palliative care in advanced 
cancer improves QoL and reduces symptom intensity6. Despite the evidence of effectiveness, significant stigma 
and confusion surrounds palliative care, and it continues to be associated only with the end of life. This means 
people who could benefit from palliative care are often not able to access it. Education and training about palliative 
care and its importance is therefore essential for all health and social care workers.  

Projects funded by the EU are demonstrating how palliative care can address complex symptoms and improve 
QoL for people living with cancer. Rehabilitation in palliative care is essential to support people to live well with 
serious illness7. For example, the INSPIRE8 project aims to improve physical function and QoL for people with 
incurable  cancer  through  the  integration  of  a  short-term  palliative  rehabilitation  intervention.  The  RELEVIUM9 
project aims to improve the QoL of people with advanced pancreatic cancer by reducing pain and cachexia through 
AI-guided care plans, alongside chemotherapy treatment. The PAINLESS10 project is testing a neuromodulation 

2 

 
 
 
 
 
 
 
 
 
technique to reduce cancer pain and the recently completed PalliativeSedation11 project explored how to relieve 
refractory  symptoms  at  the  end  of  life,  updated  a  framework  for  practice,  built  an  online  course  and  an 
accompanying e-book12 for clinicians, patients and carers. 

Recommendation: Palliative care improves outcomes for person-centred care across the cancer care 
continuum. This message must be communicated clearly, addressing the associated stigma, fear, and 
confusion of professionals, patients, family carers, and wider society. 

2. Integrate palliative care throughout the cancer care continuum 

Palliative  care  is  an  essential  component  of  healthcare  and  the  WHO  has  recommended  that  it  is  integrated 
throughout health systems13 and for all ages. Despite this, there is substantial variation in provision and access 
across  the  EU,  for  example  there  are  significant  differences  in  the  ratio  of  palliative  services  per  100.000 
inhabitants between Western Europe and Central-Eastern Europe14. 

The  INSUP-C15  project  defined  integrated  palliative  care  as  ‘bringing  together  administrative,  organisational, 
clinical and service aspects in order to realise continuity of care between all actors involved in the care network of 
patients  receiving  palliative  care.  It  aims  to  achieve  quality  of  life  and  a  well-supported  dying  process  for  the 
patient  and  the  family  in  collaboration  with  all  the  care  givers  (paid  and  unpaid)16’.  It  set  out  a  series  of 
recommendations to follow for integrating palliative care. 

The  PAL-CYCLES17  project  aims  to  develop  a  palliative  care  transition  programme  between  hospital  and  the 
community for patients with advanced cancer. It will facilitate patient-centred communication and continuity of 
care,  reducing  unplanned  hospital  admissions  and  improving  QoL  at  the  end  of  life.  STRONG-AYA18  is  a  new 
European  network  that  aims  to  improve  healthcare  services,  research  and  outcomes  for  AYA  with  cancer. 
MyPath19  will  leverage  an  innovative  digital  patient-centred  platform  to  challenge  tumour-focused  oncology 
treatment and empower patients to improve QoL and access to care. The ACTION20 project explored advance care 
planning (ACP) and demonstrated the complexity of developing ACP interventions that influence patient outcomes. 
Understanding patient preferences for future care and ensuring these inform and shape care remains a significant 
challenge. The context for end-of-life decision making differs across the EU, with assisted dying in place in some 
countries and ethical questions and assisted dying legislation being debated in others. 

Recommendation: Palliative care must be integrated across primary, secondary and tertiary care for 
children, AYA, and adults. It should be included in all cancer control and care strategies and policies.  

3. Tackle the inequities that exist in palliative care in cancer  

Social, demographic, environmental, geographical and commercial factors influence risk of cancer, outcomes in 
cancer care21, and outcomes in palliative care22. The impact of these determinants on experiences in palliative 
care has been recognised, with calls made to address them23, 24.  

Access to care across the cancer care continuum is not equitable across the EU. Tackling these inequities requires 
joint  working  between  palliative  care  and  other  specialties  such  as  oncology,  but  also  with  policy  makers  and 
sectors outside healthcare. Whilst the inequities faced by people living with cancer must be addressed, equity of 

3 

 
 
access to palliative care for all disease groups must be advocated for. Policies must not inadvertently increase 
inequity.  

The EUonQOL25 project is designing a unified QoL assessment tool that will enable the evaluation of inequities 
in QoL across the EU. Innovative social interventions are also required, and communities have an important role 
in supporting people with palliative care needs. EU Navigate26 harnesses the capacity of community navigators, 
linking them with older people living with cancer and their careers and aims to support them to improve their QoL, 
well-being and equitable access to care. 

Recommendation: The inequity of access to palliative care services for cancer and all disease groups 
must be addressed, developing and sharing social interventions that tackle the social and structural 
determinants of health. 

4. Innovate and implement new knowledge  

Innovation is essential for improving care and outcomes for people with palliative care needs. This requires new 
knowledge to be implemented across routine practice for it to achieve impact for patients and populations. 

The ESMART27 project used real-time, remote patient monitoring via mobile devices to support patients whilst 
undergoing chemotherapy. The trial demonstrated clear evidence that remote monitoring leads to a reduction in 
symptom  burden,  distress,  anxiety,  and  support  needs.  Poor  communication  between  patients  and  healthcare 
specialists  is  known  to  be  a  barrier  to  good  care.  The  MyPal28  project  designed  an  integrated  digital  health 
platform for both children and adults to address this barrier. A digital game to overcome the same barriers for 
children and AYA was also co-designed. They set out a series of recommendations for how digital methods can 
be sustainably and equitably integrated into care for children, AYA, and adults.  

PACE29 explored the complexity of implementing palliative care in practice, focusing specifically on long-term care 
facilities.  The  results  highlighted  the  differences  in  quality  of  dying  across  different  countries  in  the  EU30  and 
developed a set of tools for practitioners and policy makers to implement best palliative care practices widely. 
The  IMPACT31  project  looked  at  the  ‘knowing  and  doing’  gap  by  understanding  how  implementation  works. 
Focusing on advanced cancer and dementia, The IMPACT team developed a set of 23 quality indicators to guide 
the implementation of  palliative care in practice, covering domains such as organisation of care,  education of 
professionals and patient assessment. 

Recommendation:  Innovation  in  palliative  care  should  be  supported  and  accompanied  by  the 
dissemination of best practice and policies to support implementation. This will ensure the benefit of 
innovation reaches all those in need. 

5. Empower patients, carers, and the public to participate in palliative care 

Patients, carers, communities, and societies have a fundamental role in palliative care. Enabling and empowering 
citizens to take up this role, in partnership with healthcare providers, is an important aim of palliative care. The 
WHO has recently recognised and endorsed the importance of social participation in healthcare32. 

4 

 
 
Patients  and  carers  should  be  offered  opportunities  to  build  skills,  knowledge  and  confidence  in  caring  for 
themselves and others, enabling them to play an active role in care. The DIAdIC33 project developed a psycho-
educational intervention to support and empower people living with cancer and their family caregivers. This face-
to-face intervention demonstrated improved self-efficacy for the patient, improved coping for the caregiver and 
improved communication between the patient and caregiver. 

Digital  and  technological  innovations  can  empower  children,  AYA,  and  adults  living  with  cancer  by  removing 
barriers that can exist to participation, though attention must be paid to equity of access to digital platforms. 
Projects  such  as  MyPal34,  RELEVIUM9,  and  eSMART35  transform  patients  from  passive  recipients  of  care  to 
people who can direct and influence their own care, leading to improved outcomes for both patients and services. 

Recommendation: Models of patient, carer, and community empowerment should be developed and 
supported in palliative care. Best practice from other disciplines should be shared. 

6. Anticipate and respond to future needs 

Significant changes are taking place across the EU, and these will shape the context and need for palliative care 
in the future:  

• Dying at home 

Studies suggest the majority of people would prefer to die at home36, but rates of home death vary across the 
EU, with higher rates in the north and west, and lower rates in the south and east37. Rates of home death are 
rising, a trend that increased further during the COVID-19 pandemic in many countries38. Palliative care services 
in the community need further development and funding to respond to this rising trend.  

• Support for family carers and informal networks 

Family carers and informal networks provide the majority of care and support for people with advanced illness 
such as cancer. They are integral to improving experiences at these times and to enable people to die at home. 
They form a key part of the workforce in palliative care and must be recognised and supported. 

• Shortage of health and social care workforce  

Europe  is  experiencing  a  healthcare  workforce  crisis39,  exacerbated  by  the  COVID-19  pandemic.  This  shortage 
poses a significant threat to healthcare systems and efforts to improve access and equity in palliative care. 

• Ageing  

European life expectancy is rising, with many ageing well and living longer. It is predicted there will be close to 
half a million centenarians living in the EU by 205040. Numbers of people over 80 with cancer is predicted to 
increase, bringing new challenges for management and care, often in the context of multimorbidity or frailty41. 

Recommendation:  The  workforce  for  palliative  care  includes  health  and  social  care  professionals 
alongside family or informal carers and requires urgent recognition and support. The rising trend in 
home deaths and the ageing population require new models of care and allocation of funding. 

5 

 
 
Box – Summary of recommendations  

• Demonstrate and communicate the value of palliative care 

Palliative care improves outcomes for person-centred care across the cancer care continuum. This 
message  must  be  communicated  clearly,  addressing  the  associated  stigma,  fear,  and  confusion  of 
professionals, patients, family carers, and wider society. 

• Integrate palliative care throughout the cancer care continuum 

Palliative care must be integrated across primary, secondary and tertiary care for children, AYA, and 
adults. It should be included in all cancer control and care strategies and policies.  

• Tackle the inequities that exist in palliative care in cancer 

The inequity of access to palliative care services for cancer and all disease groups must be addressed, 
developing  and  sharing  social  interventions  that  tackle  the  social  and  structural  determinants  of 
health. 

• Innovate and implement new knowledge 

Innovation  in  palliative  care  should  be  supported  and  accompanied  by  the  dissemination  of  best 
practice and policies to support implementation. This will ensure the benefit of innovation reaches all 
those in need. 

• Empower patients, carers, and the public to participate in palliative care 

Models  of  patient,  carer,  and  community  empowerment  should  be  developed  and  supported  in 
palliative care. Best practice from other disciplines should be shared. 

• Anticipate and respond to future needs 

The workforce for palliative care includes health and social care professionals alongside family or 
informal carers and requires urgent recognition and support. The rising trend in home deaths and the 
ageing population require new models of care and allocation of funding. 

1 European Cancer Inequalities Registry: Inequalities factsheet 2040 cancer estimates May 2023. Available from: https://cancer-
inequalities.jrc.ec.europa.eu/inequalities- factsheets 
2 World Health Organisation. Palliative Care. Available from: https://www.who.int/europe/health-topics/palliative-care#tab=tab_1 
3 World Health Assembly. Resolution WHA67.19 Strengthening of palliative care as a component of comprehensive care throughout the life course. 2014. 
Available from: http://apps.who.int/gb/ebwha/pdf_ﬁles/WHA67/A67_R19-en.pdf 
4 Kavalieratos D, Corbelli J, Zhang D et al. Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-
analysis. JAMA. 2016 Nov 22;316(20):2104-2114. doi: 10.1001/jama.2016.16840 
5 Mathew C, Hsu AT, Prentice M, et al. Economic evaluations of palliative care models: A systematic review. Palliative Medicine. 2020;34(1):69-82. doi: 
10.1177/0269216319875906 

6 

 
 
 
 
 
6 Haun MW, Estel S, Rücker G et al. Early palliative care for adults with advanced cancer. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: 
CD011129. DOI: 10.1002/14651858.CD011129.pub2 
7 World Health Organisation. Policy brief on integrating rehabilitation into palliative care services. Copenhagen: WHO Regional Oﬃce for Europe; 2023. 
Licence: CC BY-NC-SA 3.0 IGO. Available from: https://iris.who.int/bitstream/handle/10665/366505/WHO-EURO-2023-5825-45590-68173-
eng.pdf?sequence=1 
8 INSPIRE https://cordis.europa.eu/project/id/101057043 
9 RELEVIUM https://cordis.europa.eu/project/id/101057821 
10 PAINLESS https://cordis.europa.eu/project/id/101057367 
11 PalliativeSedation https://cordis.europa.eu/project/id/825700 
12 PalliativeSedation ebook https://www.palliativesedation.eu/palliative-sedation-ebook/ 
13 World Health Assembly. Resolution WHA67.19 Strengthening of palliative care as a component of comprehensive care throughout the life course. 2014. 
Available from: http://apps.who.int/gb/ebwha/pdf_ﬁles/WHA67/A67_R19-en.pdf 
14 Arias-Casais N López-Fidalgo J, Garralda E et al. Trends analysis of specialized palliative care services in 51 countries of the WHO European region in the 
last 14 years. Palliat Med. 2020 Sep;34(8):1044-1056. doi: 10.1177/0269216320931341 
15 INSUP-C https://cordis.europa.eu/project/id/305555 
16 Siouta N, Van Beek K, van der Eerden ME et al. Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested 
models in cancer and chronic disease. BMC Palliat Care. 2016 Jul 8;15:56. doi: 10.1186/s12904-016-0130-7 
17 PAL-CYCLES https://cordis.europa.eu/project/id/101057243 
18 STRONG-AYA https://cordis.europa.eu/project/id/101057482 
19 MyPath https://cordis.europa.eu/project/id/101057514 
20 ACTION https://cordis.europa.eu/project/id/602541 
21 European Cancer Inequalities Registry: Inequalities factsheet 2040 cancer estimates May 2023. Available from: https://cancer-
inequalities.jrc.ec.europa.eu/inequalities- factsheets 
22 Bowers SP, Chin M, O'Riordan M et al. The end of life experiences of people living with socio-economic deprivation in the developed world: an integrative 
review. BMC Palliat Care. 2022 Nov 5;21(1):193. doi: 10.1186/s12904-022-01080-6 
23 European Observatory on Health Systems and Policies. Kaasa S, Hjermstad, MJ & Sjøgren P. Commercial and social determinants in palliative 
care. Eurohealth 2022. 28 (2), 22 - 27. World Health Organization. Regional Oﬃce for Europe. Available from: https://iris.who.int/handle/10665/353373 
24 Sallnow L, Smith R, Ahmedzai S et al. Lancet Commission on the Value of Death. Report of the Lancet Commission on the Value of Death: bringing death 
back into life. Lancet. 2022 Feb 26;399(10327):837-884. doi: 10.1016/S0140-6736(21)02314-X 
25 EUonQOL https://cordis.europa.eu/project/id/101096362 
26 EU NAVIGATE https://cordis.europa.eu/project/id/101057361 
27 ESMART https://cordis.europa.eu/project/id/602289 
28 MyPal https://cordis.europa.eu/project/id/825872 
29 PACE https://cordis.europa.eu/project/id/603111 
30 Pivodic L, Smets T, Van den Noortgate N, et al. Quality of dying and quality of end-of-life care of nursing home residents in six countries: An 
epidemiological study. Palliat Med. 2018;32(10):1584-1595. doi:10.1177/0269216318800610 
31 IMPACT https://cordis.europa.eu/project/id/258883 
32 World Health Organisation. World Health Assembly endorses resolution on social participation. 29 May 2024. Available from: 
https://www.who.int/news/item/29-05-2024-world-health-assembly-endorses-resolution-on-social-
participation#:~:text=The%20resolution%20on%20social%20participation,Meeting%20for%20UHC%202023)%3B 
33 DIAdIC https://cordis.europa.eu/project/id/825722 
34 MyPal https://cordis.europa.eu/project/id/825872 
35 ESMART https://cordis.europa.eu/project/id/602289 
36 Pinto S, Lopes S, de Sousa AB et al. Patient and Family Preferences About Place of End-of-Life Care and Death: An Umbrella Review. J Pain Symptom 
Manage. 2024 May;67(5):e439-e452. doi: 10.1016/j.jpainsymman.2024.01.014 
37 Jiang J, May P. Proportion of deaths in hospital in European countries: trends and associations from panel data (2005-2017). Eur J Public Health. 2021 
Dec 1;31(6):1176-1183. doi: 10.1093/eurpub/ckab169 
38 Lopes S, Bruno de Sousa A, Delalibera M et al. The rise of home death in the COVID-19 pandemic: a population-based study of death certiﬁcate data for 
adults from 32 countries, 2012–2021eClinicalMedicine. Jan 2024. Volume 68, 102399. 10.1016/j.eclinm.2023.102399 
39 WHO Europe Regional Oﬃce for Europe. Bucharest Declaration on the health and care workforce. 2023. Available from: 
https://iris.who.int/bitstream/handle/10665/366519/Bucharest-decl-2023-eng.pdf?sequence=1 
40 Eurostats https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Ageing_Europe_-_statistics_on_population_developments 
41 Pilleron S, Soto-Perez-de-Celis E, Vignat J, et al. Estimated global cancer incidence in the oldest adults in 2018 and projections to 2050. Int. J. 
Cancer. 2021; 148: 601–608. https://doi.org/10.1002/ijc.33232 

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