Integration of oncology and palliative care

Abstract

Background: Integration of oncology and palliative care (PC) combines two paradigms: the tumour-directed approach, which is the main focus of oncology, and the host-directed approach, which is the focus of PC. Contemporary PC aims to prevent, treat and reduce symptoms and suffering and to preserve and improve quality of life. A Lancet Oncology Commission was written on how PC and oncology can be integrated by combining these two approaches focusing content, models, organization of cancer care, public health, politics, education and research. Method(s): An international panel was established, consisting of experts in oncology, PC, public health and psycho-oncology. Literature searches were conducted, author meetings were held, and an interactive writing process was conducted. Result(s): Integration is a complex process that involves various components of the health care system. The published RCTs on integration demonstrate health gains, but how and when to integrate is uncertain. Still, early delivery of specialist palliative care promotes patient-centeredness including shared-decision making, family involvement and regular use of patient-reported outcome measures. Barriers to integration include the perception of PC as end-of-life care, deficient planning at local, national and international levels, and insufficient infrastructure and funding. Furthermore, death and dying are stigmatized. The present competence in combined oncology and PC varies substantially and must be defined at all levels. The commission proposes to use standardized care pathways (SCPs) and multidisciplinary teams (MDTs) to promote integration. Integration raises new research questions: how much, when and how should PC be delivered and what is the minimum model for good care? Conclusion(s): Integration involves the transition from a dualistic perspective - the tumor and the host- to a combined perspective. Integration must be recommended by health care authorities and decision-takers, followed by resource allocation and priority-setting. In all areas, the present volume of PC is too small to support integration on a broad scale. Implementation of integrated models is best secured by MDTs and SCPs. The combined perspective must be reflected in care models, education and research funding.