End-of-life care for non-cancer patients

The origins and early development of palliative care focussed on patients with cancer, apart from sporadic developments in a few non-malignant diseases such as motor neuron disease (MND) and acquired immunodeficiency syndrome (AIDS). In the UK, this has been compounded by the setting of palliative care outside the National Health Service, principally funded by cancer-related charities who, at the time, were instituted to relieve the suffering associated with cancer. When the modern hospice movement began, the course of malignant disease was seen as more predictable, with a defined palliative phase when anticancer treatments were no longer indicated. In the UK and many areas of the world where it was first adopted, such as Canada, USA, mainland Europe and Australia, this led to the traditional model of palliative care services, involved only in people with a prognosis of a few weeks or months. As a result, services have focused primarily on cancer leading to service and symptom management inequalities for equally needy patients with non-malignant diseases.

Meanwhile, advances in cancer therapy have changed the course of malignant diseases, in some cases, to mirror that of long-term conditions. Many palliative care services have been able to adapt their service model to one of integrated care alongside the oncology team. Although an integrated approach to palliative care access appears to be …