Integration of Oncology and Palliative Care Print Email

Integration of Oncology and Palliative Care: A Lancet Oncology Commission


“Patient-centered care should be an integral part of oncology care, independent of patient prognosis and treatment intention. To achieve this goal, it must be based on changes in professional cultures and priorities in health care.”
— The Lancet Oncology Commission

Eight MASCC members1 are part of an international team of authors who have recently reported on the integration of oncology and palliative care for the Lancet Oncology Commission, which aims to change the course of cancer in our lifetime. The Commission’s 13 priority areas, each with specific measures and metrics, represent an ambitious plan to guide researchers, funders, and policy makers in prioritizing the best research to benefit patients. With respect to palliative care, the aim of the Commission is to show why and how palliative care can be integrated with oncology for adults with cancer, irrespective of treatment intention, in high-income and middle-income countries. The report maintains that this integration will be advanced by combining two main paradigms: one tumor-directed and the other patient-directed — that is, directing equal attention toward treating the disease and focusing on the patient. The Commission addresses the task of how to combine these paradigms to achieve the best patient care outcomes.

Results of randomized clinical trials show that the integration of oncology and palliative care leads to health gains, better symptom control, improved survival, less anxiety and depression, and reduced use of ineffective treatments at the end of life. All of these result in improved quality of life for the patient, greater satisfaction for family members, and more efficient use of healthcare resources. Barriers to the successful integration of palliative care include the absence of international consensus on content and standards for palliative care education, research, and practice. Others are the common misconception that palliative care is for end-of-life care only, the stigmatization of death and dying, and insufficient infrastructure and funding. The Commission proposes the use of standardized care pathways and multidisciplinary teams to promote the integration of oncology and palliative care. It calls for changes at the system level to coordinate the activities of professionals and to develop and implement new and improved education programs, with the overall goal of improving patient care. 

This approach raises new research questions, all of which relate to the quality of clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What are the biological and clinical effects of living with advanced cancer for years after diagnosis? The Commission maintains that successful integration must challenge the dualistic perspective in which the focus is on either the tumor or the patient, and instead adopt a combined approach that places the patient’s perspective at the center. Patient-centered care should be an integral part of oncology care, independent of patient prognosis and treatment intention. Achieving this goal will require changes in professional cultures and priorities in health care at all levels, followed by adequate resource allocation, a willingness to prioritize goals and needs, and sustained enthusiasm to help generate support for better integration. It is critical that this integrated model be incorporated in international and national cancer plans and be followed by the development of new care models, as well as education and research programs, all of which will need to be adapted to the specific cultural contexts.

See the full report: Lancet Oncol. 2018 Oct 17. [Epub ahead of print]
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1Matti Aapro, MD (Genolier Cancer Centre, Genolier, Switzerland); Eduardo Bruera, MD (MD Anderson Cancer Center, Houston, Texas, USA); David C. Currow, MPH, PhD (University of Technology Sydney, Australia); Breffni Hannon, MD (Princess Margaret Cancer Centre, Toronto, Ontario, Canada); David Hui, MD, MSc (MD Anderson Cancer Center, Houston, Texas, USA); Karin Jordan, MD (University of Heidelberg, Heidelberg, Germany); Gary Rodin, MD (Princess Margaret Cancer Centre, Toronto, Ontario, Canada); Camilla Zimmermann (Princess Margaret Cancer Centre, Toronto, Ontario, Canada).