There is a growing trend in oncology, both in research and in clinical practice, toward the early integration of palliative care into regular oncology treatment, from diagnosis of advanced cancer onward. This new care approach has been developed to tackle two major problems insufficiently addressed by traditional methods which seriously affect the quality of life of advanced cancer patients – the undertreatment of symptoms and the overtreatment of the cancer itself. Although these problems can also be observed in other life-threatening diseases such as heart failure and dementia, the early integration of palliative care is gaining ground particularly in oncology, as the specific, more recognizable symptoms of advanced cancer and the relative predictability of time of death make it more suitable for early palliative care.
Recently, several models of the early integration of palliative care into regular oncological health services have been developed. In some of these models, the oncologists themselves are responsible for the palliative care of the patient during the illness trajectory, and in others specialist palliative care teams are integrated into regular oncology care. There is accumulating evidence that supports the value of early integration of specialist palliative care teams both in outpatient and inpatient settings. However, despite this evidence, palliative care is still largely seen, and applied, only in the later stages. In this chapter, several barriers to the early integration of palliative care related to healthcare professionals, to patients and family, and to the healthcare system itself are identified and discussed.
CAPC. Report card Center to Advance Palliative Care (CAPC): America’s care of serious illness—a state-by-state report card on access to palliative care in our nation’s hospitals. http://reportcard.capc.org/pdf/state-by-state-report-card.pdf. edited by Center to Advance Palliative Care (CAPC). 2015.