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Medical oncologists and supportive/palliative care education: prevention of fragmented care’
  1. Raffaele Giusti1,
  2. Giulio Ravoni2 and
  3. Giampiero Porzio2
  1. 1Medical Oncology Unit, Azienda Ospedaliero Universitaria Sant'Andrea, Rome, Italy
  2. 2Associazione Tumori Toscana Home Care Service, Florence, Italy
  1. Correspondence to Dr Raffaele Giusti, Medical Oncology Unit, Azienda Ospedaliero Universitaria Sant'Andrea, Rome, Lazio, Italy; raffaelegiusti{at}

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To the editor,

The integration between oncology and palliative care is a pivotal issue of oncological practice. Among the various integration models proposed, one of the best known, widely cited in the literature, is the one developed by Hui and Bruera.1

Bruera represents the most effective model as a cube in whose surface the team dedicated to oncological therapies and the one dedicated to the integration of supportive and palliative care.

The core of this model is a multidisciplinary team, which assesses and treats symptoms as early as possible. In the integrated care model, oncologists routinely refer patients to specialist palliative care teams early in the disease trajectory (figure 1A).

Figure 1

Model of integrated care approach: the Bruera integration model (A); the disintegration model (B).

We have expressed our doubts in the past about the real applicability of this model.2 The differences in terms of availability of human and financial resources, national and regional health system, culture, and religion make it impossible to define a single model that can be adapted to all realities.

Despite this, the model that provides for a constant integration between oncologists and palliative care specialists, through multidisciplinary teams, is seen as the reference by the most …

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  • Contributors RG, GR nd GP contributed to the concptualise and implementation of the text, to the analysis of theliterature and to the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.