Experts Offer Guidance on Integrating Palliative Services Into Cancer Care

Palliative care should be provided concurrently with cancer care early in the course of illness for all patients with advanced disease, according to a new guidance statement from the American Society of Clinical Oncology (ASCO) and the American Academy of Hospice and Palliative Medicine.

Presented last week during the 2015 ASCO Palliative Care in Oncology Symposium in Boston, the guidance statement is based on a study by an expert multidisciplinary panel made up of physicians, nurses, nurse practitioners, patient care advocates, and social workers. The panel looked at 966 different palliative care service items and ranked them according to their importance, feasibility, and whether or not the services were within the scope of oncology practice.

“Oncologists can and already do provide many palliative services, but until now, no comprehensive guidance existed on what practices should be aiming for,” said lead study author Kathleen Bickel, MD, MPhil, an assistant professor of medicine at the White River Junction Veterans Affairs Medical Center and the Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. “For the first time, we’ve set some reasonable and achievable goals for high-quality primary palliative care delivery for oncology practices in the everyday care of patients, which we hope will improve patient comfort and quality of life.”

While palliative care is known to benefit both patients and caregivers, many patients lack access to palliative care specialists. Therefore, the panel attempted to define what constitutes high-quality primary palliative care delivered in oncology practices.

The majority of services included in the definition fall into three categories: symptom assessment and management; communication and shared decision-making; and advance care planning. Specific recommendations include: manage nausea and vomiting resistant to second-line treatment; determine the patient’s and family’s understanding of prognosis; and assess the need for hospice referral at the time of diagnosis of an incurable cancer.

All symptoms should be assessed and managed at a basic level, with more comprehensive management provided for common symptoms such as nausea, vomiting, diarrhea, dyspnea, and pain, the guidance states. Clinicians should be prepared to describe to patients and families the difference between palliative care and hospice care.

The guidance statement is intended to help practices assess the care they currently provide and determine whether or not they need to add palliative care services or extend them to more patients, the panel said.

“This collaboration between professional organizations is a significant step toward accessible, high-quality palliative care for all patients,” said Don S. Dizon, MD, ASCO expert and moderator of a press conference announcing the panel’s findings. “The recommendations will help us identify essential palliative care services and set achievable goals for medical oncology practices across the country.”