Next Steps: Integration of Palliative Care Principles and Practices in Cancer Care

Next Steps: Integration of Palliative Care Principles and Practices in Cancer Care

Michael Jordan Fisch, MD, MPH, FASCO

Mar 24, 2014

"ASCO recognizes that optimal oncology care requires the integration of palliative care practices and principles across the trajectory of cancer care." That statement drew very loud and sustained applause at the annual meeting of the American Association of Hospice and Palliative Medicine (AAHPM) in March, when the AAHPM President, Dr. Amy Abernethy, recognized ASCO for its partnership and commitment to palliative care. There has been a real shift in the landscape for both cancer care and palliative care, with fabulous new opportunities emerging, yet we still have challenges to deal with (both old and new).

To continue the momentum in the field, the first co-sponsored Palliative Care in Oncology Symposium will launch October 24-25, 2014, in Boston. This follows on the heels of ASCO’s longstanding interest in symptom science across disease sites, understanding and managing cancer treatment toxicities, a focus on patient- and family-reported outcomes, and the science of outcomes measurement, as well as keen interest in effective and compassionate end-of-life care, psychosocial care, and cancer survivorship. Just like the other ASCO symposia, this meeting focused on palliative care in oncology is expected to draw a dedicated, multidisciplinary group of health professionals from oncology and related disciplines. The sessions that have been planned are creative and include the most recognized leaders in palliative care and oncology. Like other ASCO symposia, there are scientific sessions (oral abstracts and posters) where new data will be presented and discussed. This is another big step forward for cancer care, for palliative care as a discipline, and for patient and families who face serious illness.

Prior to 2006, there were few palliative care fellowships and palliative care was not a recognized subspecialty of the American Board of Medical Specialties (ABMS). This ABMS recognition finally came to fruition in 2006, and the first subspecialty certification exam in Hospice and Palliative Medicine was offered in 2008. After this event, I noticed a significant expansion of interest in this field and the growth of fellowship training opportunities and attention to the field.

The next “big bang” was the publication in the New England Journal of Medicine of Dr. Jennifer Temel’s study on the early integration of palliative care in patients with metastatic lung cancer,1 followed 18 months later by ASCO’s publication in the Journal of Clinical Oncology of its Provisional Clinical Opinion (PCO) on “The Integration of Palliative Care into Standard Oncology Care.2 The PCO concluded that “combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden.” And finally, 18 months after this PCO was published, the Institute of Medicine published on September 10, 2013, its report entitled “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis,"3 clearly acknowledging palliative care as an important component of high-quality cancer care to be initiated at the time of cancer diagnosis.

So the stage is set for the inaugural Palliative Care in Cancer Symposium in Boston on October 24-25 (see for details). The meeting is co-sponsored by the American Academy of Hospice and Palliative Medicine (AAHPM), the American Society of Radiation Oncology (ASTRO), and the Multinational Association of Supportive Care in Cancer (MASCC).

Why is it important to highlight palliative care in oncology at a meeting like this? There are many oncology meetings with some palliative and supportive care content and various palliative care and supportive care meetings that have some oncology content; however, there is a critical gap at the intersection of palliative care in oncology. This symposium addresses this gap. It will feature some of the best thinkers and key leaders in this realm, attract a multidisciplinary audience, and generate a great deal of dialogue as major challenges in science and cancer care delivery are explored. There will be tons of engagement both in person and via social media (using the hashtag #pallonc). I hope you, too, will join in to learn and share.


1.            Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363:733-42.

2.            Smith TJ, Temin S, Alesi ER, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol. 2012;30:880-7.

3.            Institute of Medicine. Delivering High Quality Cancer Care: Charting a New Course for a System in Crisis. Washington, D.C., National Academies Press, 2013.



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Nathan A. Pennell, MD, PhD

Mar, 26 2014 2:13 PM

I think it is fantastic how quickly the integration of palliative medicine and oncology has been accepted by ASCO and in major academic centers, and hope the momentum continues. My worry is in implementing this process outside of the academic center with an established palliative medicine program. We are putting together care paths for lung cancer care, and integrated palliative medicine is one of the key components of our CP. However, when presenting this to outside oncologists even within the same health system I was confronted with frustration over the lack of access most oncologists in the community have to trained pall med experts. I also have seen within our system that pall med is being recognized as valuable in diseases other than cancer, which is true and probably good for the field 0but also may cause significant stain on the scarce resources of our pall med providers. I am not sure the field can grow fast enough to keep up with the need.

Don S. Dizon, MD, FACP

Mar, 26 2014 4:39 PM

Mike: Great post, and excited to hear more from the Palliative Care symposium. At the SGO Annual Meeting this year, one of the scientific plenaries focussed on Palliative Care. Lois Ramondetta from your institution noted that increased utilization was seen when the clinic was entitled "Supportive Care" rather than "Palliative Care". The long-standing notion that palliative care = end of life care remains, with clinicians and most especially with our own patients. I do think Lois is correct- concentrating on symptoms, both physical and psychosocial, for patients living with cancer is the important mesage- more so than the lingo. Still, with the earlier implementation of palliative care for our patients, it begs the question: Where does survivorship start and stop, and where does palliative care begin and end? It is a question I tweeted to Dr. Ramondetta and the panel during the plenary SGO session and I believe it is an issue we have yet to confront as a society, but we should do so.

I mention this because I note that this meeting will include cancer survivorship as a topic. You are ahead of your time, my friend. I look forward to hearing what comes out of the inagural meeting.


Michael Jordan Fisch, MD, MPH, FASCO

Mar, 29 2014 4:40 PM

Nathan and Don, thank you both for your feedback and  enthusiasm for the Palliative Care in Oncology Symposium that is taking place in October. Your feedback highlights major challenges at the intersection of oncology and palliative care: 1) How might we ensure that there is a qualified and accessible workforce to deliver palliative care when called upon for cancer patients across the trajectory of care and in all important settings for care? 2) Are there important philosophical and/or practical distinctions between palliative care, supportive oncology care, and survivorship care as applied to patients with cancer? While there are no simple answers to these questions, we can certainly begin to make progress in tackling such important, multidisciplinary questions by having dialogue and sharing scientific papers and educational presentations at this annual #pallonc symposium. In fact, the Keynote session on Saturday, October 25th is entitled: Opportunities at the Intersection of Palliative Care, Supportive Care, and Oncology and will feature prominent experts representing ASCO, MASCC, and the AAHPM who will address some of these challenges at the same time they explore the broad scope of opportunties in this realm.

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