American Society of Clinical Oncology Provisional Clinical Opinion: The Integration of Palliative Care Into Standard Oncology Care

Abstract

ASCO's provisional clinical opinions (PCOs) reflect expert consensus based on clinical evidence and literature available at the time they are written and are intended to assist physicians in clinical decision making and identify questions and settings for further research. Because of the rapid flow of scientific information in oncology, new evidence may have emerged since the time a PCO was submitted for publication. PCOs are not continually updated and may not reflect the most recent evidence. PCOs cannot account for individual variation among patients and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient. Accordingly, adherence to any PCO is voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances. ASCO PCOs describe the use of procedures and therapies in clinical trials and cannot be assumed to apply to the use of these interventions in the context of clinical practice. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO's PCOs, or for any errors or omissions.

Cancer patients, emergencies service and provision of palliative care

“…At first, such care does not exclude specific antineoplastic therapies. 24,25 However, we see that the referral of patients to PC services has occurred repeatedly in the late stages of the disease, representing a major barrier to access in many parts of the world. 26,27 The finding that few cancer patients treated at the ER were in PC or HC promoted a discussion among professionals of the institution in order to create expansion strategies.…”

“…Several cultural and social barriers, and others associated with the training of human resources, restructuring of logic supply of care and integration of knowledge and practices that need to be overcome, 18,23,24 are reported in the implementation of PC services in Brazil and worldwide.…”

“…This is because the evidence shows that the implementation of these instances of care improves symptom control and the quality of life of cancer patients, reducing the demand for emergency care. 24,28,29 Cases that should be reviewed in other levels of care (outpatient, home, basic unit), hinder patient monitoring when treated in emergency services. This is due both to the absence of records produced in emergency settings, and the lack of an integrated system with outpatient information.…”

Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs

“…Therefore, we reviewed articles regarding disease-specific thresholds for PC to include appropriate cues for ED providers to sufficiently identify advanced disease states. 2,[81][82][83][84][85][86][87][88][89][90][91][92] Based on this review, we developed a preliminary ED-specific tool that has only three questions:…”

MASCC/ESMO/EAPC survey of palliative programs

“…Palliative Care has increasing relevance for the care of advanced cancer patients [3,4]. By improving quality of life with aggressive symptom management, reducing the cost of care, and possibly improving survival, palliative care can no longer be confused with care at the end of life [5][6][7].…”