The American Society of Clinical Oncology’s Ad Hoc Palliative Care Expert Panel has developed specific evidence-based recommendations for access to palliative care services for individuals with advanced cancer and for their family caregivers.
Cancer patients should receive palliative care early and in parallel with their active treatment plan. Referral to interdisciplinary palliative care teams is optimal and can complement existing palliative care services. Caregivers for patients may be referred to palliative care services.
These are the most significant recommendations of the American Society of Clinical Oncology (ASCO)’s Ad Hoc Palliative Care Expert Panel.
The panel worked on the guideline, which has been published in the Journal of Clinical Oncology, to update the 2012 ASCO provisional clinical option on integrating palliative care into standard oncology care. The update includes a review of 9 randomized clinical trials, 1 quasiexperimental study, and 5 secondary publications from previously reviewed randomized clinical trials, all published between March 2010 and January 2016.
The studies included patients with advanced or metastatic disease and patients with early-stage non-small cell lung cancer, plus a study that compared early with delayed palliative care. All studies included nurses in the intervention while 5 studies included palliative care specialists. All studies included outpatients. The primary outcomes of the trials included quality of life, symptom relief, psychological outcomes, survival, and satisfaction.
Based on their review of evidence, the panel developed the following specific recommendations:
The authors of the study emphasize that their evidence review supported guidelines for patients diagnosed with advanced cancer, and that existing evidence is insufficient to make strong recommendations for individuals diagnosed with early-stage disease.
The authors concluded that while interventional studies support early specialty palliative care referrals for patients with advanced-stage cancer, other triggers should be considered to ensure patients receive prompt referral to specialty palliative care services. Additionally, they emphasize the need for training oncologists in primary palliative care competencies and assessing triggers for palliative care specialty services as part of their routine caregiving to patients and their family caregivers.
Ferrell BR, Temel JS, Temin S, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline update [published October 28, 2016]. J Clin Oncol. doi: 10.1200/JCO.2016.70.1474.