ASCO Upgrades Guidelines to Include Palliative Care in Standard Oncology Care

Cancer patients should receive palliative care early and in parallel with their active treatment plan. Referral to interdisciplinary palliative care teams is optimal and can complement existing palliative care services. Caregivers for patients may be referred to palliative care services.

These are the most significant recommendations of the American Society of Clinical Oncology (ASCO)’s Ad Hoc Palliative Care Expert Panel.

The panel worked on the guideline, which has been published in the Journal of Clinical Oncology, to update the 2012 ASCO provisional clinical option on integrating palliative care into standard oncology care. The update includes a review of 9 randomized clinical trials, 1 quasiexperimental study, and 5 secondary publications from previously reviewed randomized clinical trials, all published between March 2010 and January 2016.

The studies included patients with advanced or metastatic disease and patients with early-stage non-small cell lung cancer, plus a study that compared early with delayed palliative care. All studies included nurses in the intervention while 5 studies included palliative care specialists. All studies included outpatients. The primary outcomes of the trials included quality of life, symptom relief, psychological outcomes, survival, and satisfaction.

Based on their review of evidence, the panel developed the following specific recommendations:

1. Individuals diagnosed with advanced cancer should be referred to an interdisciplinary team of palliative care consultants early in the course of their disease, in parallel with the active treatment plan.
2. Patients with advanced cancer should have access to interdisciplinary palliative care teams in the outpatient as well as inpatient settings.
3. Palliative care services for patients with advanced cancer may include the following: Building a relationship with the patient and family caregivers Symptom, distress, and functional status management Investigate patient understanding of their disease and diagnosis Clarification of treatment goals Assessment and support of coping needs Assistance with medical decision making Coordination of care with other providers Referrals to other providers as needed
4. Patients who are newly diagnosed with advanced cancer should receive a palliative care consult within 8 weeks of diagnosis.
5. For patients who have a high symptom burden or unmet physical or psychosocial needs, outpatient programs should ensure patient access to palliative care clinicians who can complement existing program tools.
6. Family caregivers caring for patients with cancer, either in the early or advanced stage, should have access to a caregiver-tailored palliative care support such as telephone coaching, education, referrals, and face-to-face meetings.

The authors of the study emphasize that their evidence review supported guidelines for patients diagnosed with advanced cancer, and that existing evidence is insufficient to make strong recommendations for individuals diagnosed with early-stage disease.

The authors concluded that while interventional studies support early specialty palliative care referrals for patients with advanced-stage cancer, other triggers should be considered to ensure patients receive prompt referral to specialty palliative care services. Additionally, they emphasize the need for training oncologists in primary palliative care competencies and assessing triggers for palliative care specialty services as part of their routine caregiving to patients and their family caregivers.

Reference

Ferrell BR, Temel JS, Temin S, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline update [published October 28, 2016]. J Clin Oncol. doi: 10.1200/JCO.2016.70.1474.