Integration of palliative care into standard oncology care: Guidelines

Palliative care is care given to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer. The goal of palliative care is to prevent or treat, as early as possible, the symptoms and side effects of the disease and its treatment, in addition to the related psychological, social, and spiritual problems. The goal is not to cure. Palliative care is also called comfort care, supportive care, and symptom management.

Palliative care is given throughout a patient’s experience with cancer. It should begin at diagnosis and continue through treatment, follow-up care, and the end of life.

In January 2017 American Society of Clinical Oncology has issued the Guidelines for Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update

Following are its major recommendations :

Clinical Question 1

What is the most effective way to care for patients with advanced cancer symptoms (palliative care services in addition to usual care compared with usual care alone)?

Recommendation 1

Patients with advanced cancer should be referred to interdisciplinary palliative care teams (consultation) that provide inpatient and outpatient care early in the course of disease, alongside active treatment of their cancer (type: evidence based, benefits outweigh harms; evidence quality: intermediate; strength of recommendation: strong).

Clinical Question 2

What are the most practical models of palliative care? Who should deliver palliative care (external consultation, internal consultations with palliative care practitioners in the oncology practice, or performed by the oncologist him- or herself)?

Recommendation 2

Palliative care for patients with advanced cancer should be delivered through interdisciplinary palliative care teams, with consultation available in both outpatient and inpatient settings (type: evidence based, benefits outweigh harms; evidence quality: intermediate; strength of recommendation: moderate).

Clinical Question 3

How is palliative care in oncology defined or conceptualized?

Recommendation 3

Patients with advanced cancer should receive palliative care services, which may include a referral to a palliative care provider. Essential components of palliative care include: rapport and relationship building with patient and family caregivers; symptom, distress, and functional status management (e.g., pain, dyspnea, fatigue, sleep disturbance, mood, nausea, or constipation); exploration of understanding and education about illness and prognosis; clarification of treatment goals; assessment and support of coping needs (e.g., provision of dignity therapy); assistance with medical decision making; coordination with other care providers; and provision of referrals to other care providers as indicated. For newly diagnosed patients with advanced cancer, the Expert Panel suggests early palliative care involvement, starting early in the diagnosis process and ideally within 8 weeks of diagnosis (type: informal consensus; evidence quality: intermediate; strength of recommendation: moderate).

Clinical Question 4

How can palliative care services relate in practice to other existing or emerging supportive care services (including nurse navigation, lay navigation, community and home health care, geriatric oncology, psycho-oncology, and pain services)?

Recommendation 4

Among patients with cancer with high symptom burden and/or unmet physical or psychosocial needs, outpatient programs of cancer care should provide and use dedicated resources (palliative care clinicians) to deliver palliative care services to complement existing program tools (type: informal consensus, benefits outweigh harms; evidence quality: intermediate; strength of recommendation: moderate).

Clinical Question 5

Which interventions are helpful for family caregivers?

Recommendation 5

For patients with early or advanced cancer for whom family caregivers will provide care in outpatient, home, or community settings, nurses, social workers, or other providers may initiate caregiver-tailored palliative care support, which could include telephone coaching, education, referrals, and face-to-face meetings. For family caregivers who may live in rural areas and/or are unable to travel to clinic and/or longer distances, telephone support may be offered (type: evidence based; evidence quality: low; strength of recommendation: weak).

Clinical Question 6

Which patients should be offered or referred to palliative care services, and when in their disease trajectory; are there triggers that should be used to prompt specialty palliative care referrals?

Special Commentary

Interventional studies support early specialty palliative care referrals among patients with advanced-stage malignancies and their caregivers. However, additional triggers should be considered among all patients with cancer to ensure prompt referrals to specialty palliative care services for patients at high risk for specialty palliative care needs. Furthermore, oncologists should be educated in primary palliative care competencies and regularly assess triggers for palliative care specialty services as part of their care of patients with cancer and their family caregivers. Additional studies are needed to better define triggers for meeting unmet specialty palliative care needs in the population of patients with cancer.

For more details and reading the full guideline, click on the link : Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T, Stovall EL, Zimmermann C, Smith TJ. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017 Jan;35(1):96-112. [73 references] PubMed