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  • Review Article
  • Published:

Integrating palliative care into the trajectory of cancer care

Nature Reviews Clinical Oncology volume 13, pages 159–171 (2016)Cite this article

Subjects

Key Points

  • Patient referral to specialist palliative care is associated with improved quality of life, symptom control, patient and caregiver satisfaction, illness understanding, end-of-life care, costs of care, and, potentially, survival

  • Oncologists and general practitioners have an important role in the delivery of primary palliative care, and in facilitating timely referral of patients to specialist palliative-care teams

  • The integration of oncological and palliative care needs to be tailored to the demands of the individual health-care system and hospital setting, according to the resources available locally

  • Outpatient palliative-care clinics are a hallmark of integration, providing patients with access to specialist palliative care early in the disease trajectory, and can accommodate multiple repeat visits over time

  • Routine symptom screening with automatic referral criteria, combined (multidisciplinary) patient-care rounds, renaming palliative care to 'supportive care', and embedded oncology–palliative-care clinics represent potential strategies to encourage integration of care

  • Education initiatives include a mandatory palliative-care rotation for oncology fellows, combined palliative care and oncology educational activities for trainees, and continuing medical education in palliative care for practicing oncologists

Abstract

Over the past five decades, palliative care has evolved from serving patients at the end of life into a highly specialized discipline focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. A growing body of evidence is now available to inform the key domains in the practice of palliative care, including symptom management, psychosocial care, communication, decision-making, and end-of-life care. Findings from multiple studies indicate that integrating palliative care early in the disease trajectory can result in improvements in quality of life, symptom control, patient and caregiver satisfaction, illness understanding, quality of end-of-life care, survival, and costs of care. In this narrative Review, we discuss various strategies to integrate oncology and palliative care by optimizing clinical infrastructures, processes, education, and research. The goal of integration is to maximize patient access to palliative care and, ultimately, to improve patient outcomes. We provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. We also discuss how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available.

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Figure 1: Conceptual framework for supportive care, palliative care and hospice care, based on a systematic literature review4.
Figure 2: Indicators of successful integration of palliative care into oncology practice.
Figure 3: Care needs of patients with advanced-stage cancer.
Figure 4: Management of personal care needs.
Figure 5: Palliative-care-referral patterns.

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Acknowledgements

The work of D.H. is supported in part by a Mentored Research Scholar Grant in Applied and Clinical Research (MRSG-14-148-01–CCE) from the American Cancer Society, and a National Institutes of Health grant (R21CA186000-01A1). The work of E.B. is supported in part by National Institutes of Health grants R01NR010162-01A1, R01CA122292-01, and R01CA124481-01.

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  1. Department of Palliative Care & Rehabilitation Medicine, Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, 77030, Texas, USA

    David Hui & Eduardo Bruera

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Both authors researched data for the article, contributed to discussion of content, and wrote and reviewed/edited the manuscript before submission.

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Correspondence to Eduardo Bruera.

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Hui, D., Bruera, E. Integrating palliative care into the trajectory of cancer care. Nat Rev Clin Oncol 13, 159–171 (2016). https://doi.org/10.1038/nrclinonc.2015.201

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