Palliative and End-of-Life Care

Palliative care in oncology focuses on preventing and relieving suffering and improving quality of life for people with serious cancer, addressing physical, psychological, social, and spiritual needs. End-of-life care is the part of palliative care concerned with the final phase of life. Contemporary practice integrates palliative care alongside active cancer treatment rather than reserving it for the end of life.

Definition

Palliative care in oncology is interdisciplinary care aimed at relieving suffering and supporting quality of life across the trajectory of serious cancer; end-of-life care is its application during the dying phase.

Scope

This entry covers the goals and domains of palliative care in cancer, the distinction and relationship between palliative and end-of-life care, the evidence for early integration with oncology, and the structures through which it is delivered. It is a reference overview and does not provide individual care plans, symptom-management regimens, or prognostic guidance.

Core questions

• What are the goals and domains of palliative care in cancer?
• How do palliative care and end-of-life care relate to each other?
• What is the evidence for integrating palliative care early with oncology?
• Through what structures and teams is palliative care delivered?

Key concepts

• Relief of suffering and quality of life as primary aims
• Physical, psychological, social, and spiritual domains
• Early integration with oncology care
• Interdisciplinary palliative care team
• Goals-of-care and advance care planning
• Hospice and the dying phase

Clinical relevance

Randomised trials in advanced cancer have found that introducing palliative care early, alongside standard oncology treatment, can improve quality of life and mood (Temel, 2010; Bakitas, 2009), and professional guidelines now recommend such integration as part of routine cancer care (Ferrell, 2017). This entry describes those findings and frameworks for orientation and is not a source of individual care or prognostic guidance.

Evidence & guidelines

Landmark randomised trials support early palliative care in advanced cancer (Temel, 2010; Bakitas, 2009). ASCO recommends integrating palliative care into standard oncology care (Ferrell, 2017), and the National Consensus Project sets out clinical practice guidelines for quality palliative care across its physical, psychological, social, spiritual, and ethical domains (Ferrell, 2018).

History

Palliative care grew out of the modern hospice movement of the mid-twentieth century and broadened from end-of-life care into a discipline spanning the trajectory of serious illness. In oncology, the publication of randomised trials of early palliative care around 2009-2010 and subsequent professional guidelines shifted practice toward integrating palliative care alongside active cancer treatment.

Debates

When should palliative care be introduced?

Evidence and guidelines support early, concurrent palliative care in advanced cancer, but questions remain about optimal timing, which patients benefit most, and how to deliver it given limited specialist palliative-care capacity.

Key figures

• Jennifer Temel
• Marie Bakitas
• Betty Ferrell
• Diane Meier

Seminal works

• temel-2010
• bakitas-2009
• ferrell-2017

Frequently asked questions

Is palliative care the same as end-of-life care?

Not quite. End-of-life care is part of palliative care, focused on the final phase of life, but palliative care more broadly aims to relieve suffering and support quality of life across the course of a serious illness, including alongside active treatment.

Does palliative care mean stopping cancer treatment?

No. Contemporary practice integrates palliative care alongside active anticancer treatment; trials of early palliative care enrolled patients who were also receiving oncology care.