For patients with advanced cancer, palliative care should start early and be an integral part of treatment, not just something added on near the end of life, according to a new practice guideline from the American Society for Clinical Oncology (ASCO).
Expanding on a 2012 opinion, the guideline authors say that caregivers of advanced-cancer patients and early-stage cancer patients should also be considered for palliative - sometimes known as "comfort" - care.
Palliative care teams help build rapport and relationships with patients and family caregivers, manage symptoms like fatigue, mood changes and nausea, clarify treatment goals, assist with medical decision making and generally help patients cope with having cancer.
"Most hospitals and most cancer centers have palliative care, but most patients only get to palliative care in the last weeks and months of life," said lead author Betty R. Ferrell of the City of Hope Medical Center in Duarte, California. "Patients really need to get these services early in the disease course, while still getting chemotherapy and other disease focused treatments."
People who get palliative care tend to live longer, have better symptom management and better quality of life, she told Reuters Health by email. Many cancer patients, even those who are not within weeks of death, can reap those benefits, she said.
In 2012, ASCO released a provisional clinical opinion on integrating palliative care into treatment for all cancer patients. The new guideline updates and reinforces that opinion with a review of nine new randomized controlled trials and a secondary analysis of five trials included in the 2012 statement.
"In the four years since, one of the reasons why ASCO decided to move forward with these recommendations is there has been much more research and evidence," Ferrell said of the new guideline, published in the Journal of Clinical Oncology.
All patients diagnosed with advanced cancer, whether inpatients or outpatients, should receive dedicated palliative care alongside active cancer treatment like chemotherapy, the guideline states.
Advanced cancer includes patients with distant metastases, late-stage disease, cancer that is life limiting, or with prognosis of six to 24 months.
For these patients, the oncology team should make a referral to a palliative care team within eight weeks of cancer diagnosis.
Oncologists may make the same referral for patients with early-stage cancer as well, the authors advise.
"Over 90 percent of hospitals with more than 300 beds have palliative care available," and what few gaps there are tend to be at small, rural hospitals, Ferrell said.
Cancer center administration should develop structures and practices to ensure people get care they need, she told Reuters Health. But the palliative care team may not be able to meet with every patient at a cancer center.
"At the generalist level, everyone practicing in oncology, every oncology nurse, needs to have a generalist knowledge of palliative care," Ferrell said.
"Every clinician in cancer care is providing palliative care," she said.
Patients who are older, have heart disease, pulmonary disease or just many symptoms may be more complicated and require the attention of a multidisciplinary team, she said.