In 2016, the American Society of Clinical Oncology published an update to their 2012 guideline. These recommendations integrate new evidence about palliative care provision in oncology. The summary recommendation states:

“Inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment. Referral of patients to interdisciplinary palliative care teams is optimal, and services may complement existing programs. Providers may refer family and friend caregivers of patients with early or advanced cancer to palliative care services.”

This guideline update focuses primarily on the role of specialty palliative care, in standard oncology care. It also provides direction on the elements of palliative care that should be provided for oncology patients:

  • “Rapport and relationship building with patient and family caregivers”
  • “Symptom, distress, and functional status management (e.g., pain, dyspnea, fatigue, sleep disturbance, mood, nausea, or constipation)”
  • “Exploration of understanding and education about illness and prognosis”
  • “Clarification of treatment goals”
  • “Assessment and support of coping needs (e.g., provision of dignity therapy)”
  • “Assistance with medical decision making”
  • “Coordination with other care providers”
  • “Provision of referrals to other care providers as indicated”

While not directly stated, most of these elements of palliative care are delivered using a primary palliative care approach by the oncology team members, which also “may include a referral to a palliative care provider.”  However, “whether improved outcomes can be achieved through changes in health care delivery and training by oncology care providers has not been studied.” While a great deal of research has focused on specialist palliative care, we now need evidence about the outcomes associated with primary palliative care delivery through standard specialty care teams, using specialist palliative care as the back-up, for the complex, challenging and messy situations.

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