# Make early palliative care and a goals conversation part of every advanced-cancer pathway

Source: https://onco.cc/ideas/idea-cost-early-palliative-default/  
OnCo record `idea-cost-early-palliative-default` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Chemotherapy in the last two weeks of life rarely helps and costs a great deal; patients who have an early conversation about what matters to them choose it less often and live at least as long.

## Summary

Randomised trials of early specialist palliative care alongside cancer treatment in advanced lung and other cancers have shown better quality of life, less aggressive end-of-life care and, in some trials, longer survival. ASCO's Choosing Wisely list names chemotherapy for patients with poor performance status and no benefit from prior treatment as care to avoid. Embedding a structured serious-illness conversation at the start of any non-curative line, and automatic palliative referral at metastatic diagnosis, changes the default without restricting anyone's choice.

## Fields

- Kind: Idea
- Last checked: 2026-09-10
- Hypothesis: Default early palliative referral will reduce chemotherapy in the last 14 days of life and intensive-care admissions in the last 30 days by a third, with no reduction in survival and lower end-of-life spending.
- Rationale: The trials are done; uptake is limited by workforce and by the absence of a pathway trigger.
- Proposed test: Health-system pathway change with end-of-life quality indicators, patient-reported outcomes and spending compared with matched systems.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- ASCO: Choosing Wisely recommendations: https://www.asco.org/news-initiatives/current-initiatives/cancer-care-initiatives/choosing-wisely

## Connected records

- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/)
- bottlenecks: [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Pain relief and palliative care are unavailable to most](https://onco.cc/bottlenecks/b-palliative/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)

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