FROM THE JOURNAL OF CLINICAL ONCOLOGY
Patients with advanced cancer should receive dedicated palliative care services early in the disease course, concurrently with active treatment, according to the American Society of Clinical Oncology’s new guidelines on the integration of palliative care into standard oncology care.
Ideally, patients should be referred to interdisciplinary palliative care teams within 8 weeks of cancer diagnosis, and palliative care should be available in both the inpatient and outpatient setting, recommended ASCO.
The guidelines, which updated and expanded the 2012 ASCO provisional clinical opinion, were developed by a multidisciplinary expert panel that systematically reviewed phase III randomized controlled trials, secondary analyses of those trials, and meta-analyses that were published between March 2010 and January 2016.
According to the panel, essential components of palliative care include:
• Rapport and relationship building with patient and family caregivers.
• Symptom, distress, and functional status management.
• Exploration of understanding and education about illness and prognosis.
• Clarification of treatment goals.
• Assessment and support of coping needs.
• Assistance with medical decision making.
• Coordination with other care providers.
• Provision of referrals to other care providers as indicated.
The panel makes the case that not only does palliative care improve care for patients and families, it also likely reduces the total cost of care, often substantially. However, “race, poverty and low socioeconomic and/or immigration status are determinants of barriers to palliative care,” wrote the expert panel, which was cochaired by Betty Ferrell, PhD, of the City of Hope Medical Center, Duarte, Calif., and Thomas Smith, MD, of the Sidney Kimmel Comprehensive Cancer Center in Baltimore.
While it was not “within the scope of this guideline to examine specific factors contributing to disparities,” the panel urged health care providers to be aware of the paucity of health disparities research on palliative care and to “strive to deliver the highest level of cancer care to these vulnerable populations.”
Read the full guidelines here .
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