Early integrated palliative care
Specialist care for symptoms, decision-making and quality of life given alongside cancer treatment from diagnosis, not just at the end. Trials show it improves quality of life and mood and may lengthen survival.
Palliative care is the interdisciplinary management of physical, psychological, social and spiritual suffering. Temel's randomised trial (NEJM 2010) in metastatic NSCLC showed early palliative care improved quality of life and depression and, unexpectedly, survival (11.6 vs 8.9 months) with less aggressive end-of-life care. Subsequent trials (ENABLE III, Zimmermann 2014, Bakitas) and meta-analyses confirmed quality-of-life and caregiver benefits; ASCO (2017, updated 2024) recommends concurrent palliative care for all patients with advanced cancer within 8 weeks of diagnosis. Delivery models include embedded clinics, telehealth (REACH PC showed video equivalent to in-person, JAMA 2024), nurse-led and primary palliative care by oncologists. The workforce gap is global: most LMICs lack access to palliative care and opioids.
How it works
Systematic symptom assessment (ESAS, PRO-based), goals-of-care and prognostic communication (serious illness conversations), advance care planning and caregiver support delivered by a specialist team working in parallel with disease-directed treatment.
- Randomised evidence for better quality of life, mood and end-of-life care
- Reduces futile treatment and hospital deaths
- Telehealth delivery is equivalent to in-person
- Workforce shortage; referral often late or never
- Perceived by patients and oncologists as 'giving up'
- Opioid access absent in much of the world
Latest papers
topQuery for this technology: (TITLE:"Early integrated palliative care" OR ABSTRACT:"Early integrated palliative care") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Early integrated palliative care, not a curated reading list.
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