ASCO has released a provisional clinical opinion (PCO) recommending the use of palliative care alongside standard oncologic therapy for patients newly diagnosed with metastatic cancer. The PCO is based on data from seven randomized clinical trials (RCTs), but the strongest evidence came from a phase III trial comparing palliative care plus standard cancer treatment with standard treatment alone in 151 patients. Temel et al. reported that early use of palliative care improves quality of life and reduces the occurrence of depressive symptoms. Furthermore, the patients who received interdisciplinary palliative care had a better understanding of their prognosis and lived longer than those who did not. Importantly, the added benefits (when reported) came at no extra cost and caused no harm.

In many cases, palliative care is only provided to patients with advanced cancer after all treatment options have been exhausted, which perhaps explains why it is often confused with end-of-life care. “In the USA, one-third of patients with cancer go into hospice with fewer than 7 days to live,” explains the ASCO panel co-chair Thomas Smith. 'Start sooner,' is the take-home message from the panel's PCO. Hospices provide a number of services that are beneficial to patients: the findings of the RCTs examined by the panel indicate that extending services such as meticulous symptom assessment and control, counselling, and illness education to patients at the time of diagnosis can improve patient and caregiver outcomes, as well as honor patient choice.

“Right now, 60% of oncologists prefer not to discuss advanced directives, durable power of medical attorney or use of hospice until no more chemo is left,” Smith continues. The delay means that patients might miss out on finding spiritual and family peace, which can have a detrimental effect on quality of life.

Despite these positive findings, data on the effects of integrated palliative care in the oncologic setting are incomplete. ASCO encourages research into determining the optimal timing and venue, as well as the components of palliative care that provide the best outcomes.