By Betty R. Ferrell, PhD, MA, FAAN, FPCN, and Thomas J. Smith, MD, FAAHPM, FASCO
Co-Chairs, ASCO Palliative Care Expert Panel
ASCO has issued recommendations for oncology clinicians to ensure that palliative care is best integrated in cancer care. Building on a 2012 ASCO Provisional Opinion on this topic, the new “Integration of Palliative Care Into Standard Oncology Care: ASCO Clinical Practice Guideline Update” builds on mounting evidence of the benefits of concurrent palliative care across the trajectory of cancer.
With our co-chair Jennifer S. Temel, MD, we had the honor of leading the Palliative Care Expert Panel for this important and timely update. The Expert Panel reviewed all available evidence and concluded that, as stated in the guideline, “Inpatients and outpatients with advanced cancer should receive dedicated palliative care services early in the disease course, concurrent with active treatment. Referring patients to interdisciplinary palliative care teams is optimal and services may complement existing programs.”
The Expert Panel recognized the many benefits of palliative care integration, including symptom management, clarification of treatment goals, support of coping and distress management, and coordination of care. Palliative care is a team effort, with interdisciplinary colleagues contributing to meet patient and family caregiver needs amidst health systems that are becoming more complex, with more available treatment options.
The foundation of the guideline update is that palliative care should apply from the time of diagnosis, and through treatment, recurrence, and long-term survivorship or the end of life. In the service of this goal, the Expert Panel made the following conclusions and recommendations:
- There is expert consensus, based on our thorough literature review, for offering palliative care concurrently with antitumor therapy.
- For newly diagnosed patients with advanced cancer, early palliative care should begin within 8 weeks of diagnosis.
- Palliative care should be interdisciplinary.
- Palliative care has much to offer to manage quality-of-life concerns in cancer survivors.
- Family caregivers are the key providers of patient care and need education, support, and skills preparedness; providers may refer caregivers of patients with early or advanced cancer to palliative care services.
- Patients participating in clinical trials can benefit from palliative care.
- There is growing evidence of the cost benefits of palliative care, in addition to better quality of care and equal or longer survival.
The Expert Panel affirmed the definition of palliative care as “care which optimizes quality of life by anticipating, preventing, and treating suffering.”
Read the full text of the updated guideline and find supplementary materials, including a summary, slide set, and tables. To comment on published guidelines or provide new evidence, visit the ASCO Guidelines Wiki. The guideline will be discussed at the 2017 ASCO Annual Meeting during the “Using the New ASCO Clinical Practice Guideline for Palliative Care” session (check online for the latest Annual Meeting information).