Cancer Care Incomplete Without Palliative Care Integration

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Michael J. Fisch, MD, MPH, FACP, FAAHPM

Jamie H. Von Roenn, MD

If we practice in accordance with the Hippocratic Oath, then we have committed to making sure our patients live as well as they can, not just as long as they can.

— Jamie H. Von Roenn, MD

ASCO recognizes that an array of efforts are needed to fully integrate palliative care into the cancer care continuum, and the Society is committed to facilitating the integration of palliative cancer care into existing health-care systems worldwide in order to realize the vision of comprehensive cancer care by 2020.

ASCO issued its first policy statement on palliative care in oncology in 1998, emphasizing the critical role that palliative care plays in providing high-quality care for cancer patients and their families. In 2009, the Society issued a second statement on palliative care, calling for a broad range of recommendations to increase education and awareness among providers and the public as well as systems-level change to ensure access to these critical services for patients and their families.

Most recently, ASCO’s 2012 Provisional Clinical Opinion recommended early integration of palliative care for all patients with advanced disease or a high symptom burden, regardless of prognosis. ASCO is now expanding its palliative care initiatives with the Palliative Care in Oncology Symposium and a new Palliative Care Resource Center.

“ASCO’s efforts in palliative care are not new, but they have increased and become more visible recently,” said Jamie H. Von Roenn, MD, ASCO’s Senior Director of Education, Science, and Professional Development. “Palliative care is an essential component of optimal oncology care, regardless of stage and prognosis.”

What Is Palliative Care?

Long misunderstood or misidentified, the World Health Organization defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual in conjunction with (or without) anticancer treatment.”

According to Michael J. Fisch, MD, MPH, FACP, FAAHPM, Chair of the Department of General Oncology at The University of Texas MD Anderson Cancer Center, the field of palliative care remains poorly understood by the lay public and by some cancer and health-care professionals.

“I think too many people still associate palliative care with hospice,” Dr. Fisch said. “People who do not perceive themselves as having end-of-life issues may turn away from palliative care or be confused about why it is being brought up, rather than seeing the early integration of palliative care as a part of a program of ambitious goals to move toward impeccable assessment and management of symptoms and post-treatment survivorship. Palliative care provides an extra layer of support that can make a big difference for patients and families.”

Palliative Care in Oncology Symposium

One of ASCO’s most visible efforts is the Palliative Care in Oncology Symposium, which took place October 24 to 25 in Boston. The meeting theme was “Patient-Centered Care Across the Cancer Continuum.” ASCO is a cosponsor of the meeting, along with American Academy of Hospice and Palliative Medicine, the American Society for Radiation Oncology, and the Multinational Association of Supportive Care in Cancer Annual Meeting.

According to Dr. Fisch, the meeting cosponsors have tapped into an unmet need with this symposium, which is providing an interface between oncology and palliative care.

“One of the challenges of the ASCO Annual Meeting is that the palliative care content is pulled out into its own session,” said Jennifer S. Temel, MD, Clinical Director of Thoracic Oncology at Massachusetts General Hospital. “It can be difficult to get to more than one session, and since clinically I am interested in lung cancer, it would be hard not to make going to the lung cancer sessions the priority.”

Sessions at the Palliative Care in Oncology Symposium addressed a wide range of relevant topics including symptom management, patient survivorship care, end-of-life issues, the early integration of palliative care, and psycho-oncology. Interest in the meeting was evident by the attendance.

“Interest in the Palliative Care in Oncology Symposium exceeded our expectations,” Dr. Von Roenn said. “We had planned for about 350 attendees, and we registered more than 650, which was the maximum that we can accommodate so we ended up having a waiting list.”

According to Dr. Von Roenn, the attendance speaks to the growing importance of the issue of palliative care and the need for a forum for researchers to discuss and learn about current therapies, interventions, and paths forward.

The next Palliative Care in Oncology Symposium will accommodate a larger number of attendees and is scheduled for October 2 to 3, 2015, in Boston. To learn more, visit

Resource Center

For those interested in palliative care who could not attend the symposium, ASCO provides a wide variety of palliative care resources on its website ( Members who visit can find out more about upcoming meetings and courses, including opportunities to attend workshops or complete online education activities.

The website also includes a compilation of relevant guidelines, tools, and resources related to palliative care. Members can access ASCO’s Provisional Clinical Opinion on the integration of palliative care, find out more about Quality Oncology Practice Initiative measures for palliative care, or access other practice improvement resources addressing topics such as emotional well-being, fertility preservation, pain management, and more.

Drs. Fisch, Temel, and Von Roenn all stressed that palliative care is an issue that concerns all oncologists.

“If we practice in accordance with the Hippocratic Oath, then we have committed to making sure our patients live as well as they can, not just as long as they can,” Dr. Von Roenn said. ■

© 2014. American Society of Clinical Oncology. All rights reserved.