Early integration of palliative care services with standard oncology care for patients with advanced cancer


  • Joseph A. Greer PhD,

    Corresponding author
    • Assistant Professor of Psychology, Harvard Medical School, and Assistant in Psychology, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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  • Vicki A. Jackson MD, MPH,

    1. Assistant Professor of Medicine, Harvard Medical School, and Chief, Palliative Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
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  • Diane E. Meier MD, FACP,

    1. Director, Center to Advance Palliative Care, Vice Chair for Public Policy, Hertzberg Palliative Care Institute, Professor of Geriatrics and Internal Medicine, and Catherine Gaisman Professor of Medical Ethics at Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, NY
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  • Jennifer S. Temel MD

    1. Associate Professor of Medicine, Harvard Medical School, and Associate Physician of Medicine, Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
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  • DISCLOSURES: Supported in part by an American Society of Clinical Oncology Career Development Award to Dr. Temel and gifts from the Joanne Hill Monahan Cancer Fund and Golf Fights Cancer.

Corresponding author: Joseph A. Greer, PhD, Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Yawkey Building, 55 Fruit St, Boston, MA 02114; jgreer2@partners.org


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Scientific advances in novel cancer therapeutics have led to remarkable changes in oncology practice and longer lives for patients diagnosed with incurable malignancies. However, the myriad options for treatment have established a culture of cancer care that has not been matched with a similar availability of efficacious supportive care interventions aimed at relieving debilitating symptoms due to progressive disease and treatment side effects. Accumulating data show that the introduction of palliative care services at the time of diagnosis of advanced cancer leads to meaningful improvement in the experiences of patients and family caregivers by emphasizing symptom management, quality of life, and treatment planning. In this review article, the rationale and evidence base for this model of early palliative care services integrated into standard oncology care are presented. In addition, the implications and limitations of the existing data to 1) elucidate the mechanisms by which early palliative care benefits patients and families; 2) guide the dissemination and application of this model in outpatient settings; and 3) inform health care policy regarding the delivery of high-quality, cost-effective, and comprehensive cancer care are discussed. CA Cancer J Clin 2013;63:349-363. © 2013 American Cancer Society, Inc.