Over the past decade, a large body of literature has accumulated supporting the integration of palliative care into oncology practice for patients with advanced cancer. The question is no longer whether palliative care should be offered, but what is the optimal model of delivery, when is the ideal time to refer, who is in greatest need of a referral, and how much palliative care should oncologists themselves be providing. This objective of this session is to discuss how different models of palliative care can address the care needs of cancer patients along the disease trajectory. We will provide an evidence-based review of randomized controlled trials on integration of palliative care and oncology. It is important to recognize that these clinical trials have examined many different approaches to palliative care delivery. In the outpatient setting alone, investigators have studied (1) Interdisciplinary Specialist Palliative Care in Stand-Alone Clinics, (2) Physician-Only Specialist Palliative Care in Stand-Alone Clinics, (3) Nurse-Led Specialist Palliative Care in Stand-Alone Clinics, (4) Nurse-Led Specialist Palliative Care Telephone-Based Interventions, (5) Embedded Specialist Palliative Care with Variable Team Makeup, and (6) Advanced Practice Providers-Based Enhanced Primary Palliative Care. The diversity of models has helped to highlight that timely involvement and interdisciplinary engagement are the two essential elements to optimize outcomes. We will highlight the key concept that palliative care, at its best, is a form of preventative care. Timely palliative care interventions can help to prevent catastrophes such as pain crisis and intensive care unit admissions. We will discuss the optimal timing for referral to specialist palliative care. We will review the pros and cons of various specialist palliative care outpatient models, such as stand-alone clinics, embedded clinics and nurse-led clinics. We will also discuss how automatic referral can facilitate systematic access to timely palliative care. The prerequisites to automatic referral include routine screening of supportive care needs, consensus referral criteria, a mechanism to trigger referrals and availability of palliative care service. We will end this session by discussing the extent of integration of palliative care and oncology in different health systems and areas for future development.
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