A Framework for Palliative Care Integration in Cancer Care: Biren Saraiya, MD

Palliative care is a continuum that every oncology professional already participates in, often without recognizing it, says Biren Saraiya, MD, medical oncologist and medical director, Office of Human Research Subjects, Rutgers Cancer Institute, in an interview with The American Journal of Managed Care^® ahead of his presentation at the 2026 annual meeting of the American Society of Clinical Oncology.

Redefining Palliative Care: Primary vs Secondary

Saraiya defines palliative care by its root meaning, which is simply the alleviation of symptoms. Within that framework, he distinguishes 2 tiers. Primary palliative care is delivered by the treating team, including the surgeon managing postoperative pain, the radiation oncologist relieving bone pain, and the medical oncologist addressing anxiety and treatment decision fatigue. Secondary palliative care involves specialists equipped to escalate management when the primary team's capacity is exceeded. This includes patients with complex pain requiring escalating opioid regimens, those facing difficult decision-making around disease trajectory, or those carrying symptom burdens the oncology team cannot adequately control.

The argument for early integration of secondary palliative care is well-supported by a now-substantial evidence base. The journey began in lung cancer roughly 15 years ago, when a landmark randomized trial demonstrated that early integration not only improved symptom control and mood but also improved survival. Since then, studies have confirmed consistent benefits in symptom control and quality of life across multiple cancer types, even where survival gains remain disease-specific.

Three Barriers That Must Be Addressed

Saraiya identifies 3 interconnected obstacles to early palliative care in practice. The first is access and insurance coverage, as he explains that outpatient palliative care has historically been inadequately reimbursed. New Jersey's 2023 Medicaid law, which Saraiya helped advocate for, now mandates coverage for outpatient palliative care, but the gap persists for Medicare and privately insured patients nationally. The second barrier is the workforce, as there are simply not enough palliative care specialists to meet demand. Telehealth and remote palliative care visits offer partial solutions, particularly for geographically dispersed or immobile patients. The third is institutional, as health systems under productivity pressure may fail to grow or sustain palliative care teams unless those teams are utilized in ways that demonstrate measurable value. Oncologists partnering with palliative care services to ensure appropriate referral volume is one lever for sustaining programmatic capacity.