Integrating Supportive and Palliative Care in the Trajectory of Cancer: Establishing Goals and Models of Care

Patients with advanced cancer frequently experience significant symptom burden and psychosocial distress. Palliative care has evolved as a discipline that addresses many of these concerns. Yet, palliative care referrals remain delayed as patients continue to focus on cancer treatments. Using a car analogy, we propose that the two seemingly opposing goals of care - receipt of cancer therapies and symptom management - can be addressed concurrently under an integrated-care model. To ensure high quality and early access to supportive/palliative care services, oncologists need to be comfortable with the core competencies related to symptom management, psychosocial interventions, communication, and transition of care. For patients with severe distress, early referral to the interdisciplinary supportive/palliative care team is recommended. Through better integration and education, oncologists and supportive/palliative care specialists can work together to minimize the burden of progressive cancer for patients like Tom. © 2010 by American Society of Clinical Oncology.