{"entity":{"id":"palliative-care","kind":"technology","name":"Early integrated palliative care","aka":[],"tldr":"Specialist care for symptoms, decision-making and quality of life given alongside cancer treatment from diagnosis, not just at the end. Trials show it improves quality of life and mood and may lengthen survival.","summary":"Palliative care is the interdisciplinary management of physical, psychological, social and spiritual suffering. Temel's randomised trial (NEJM 2010) in metastatic NSCLC showed early palliative care improved quality of life and depression and, unexpectedly, survival (11.6 vs 8.9 months) with less aggressive end-of-life care. Subsequent trials (ENABLE III, Zimmermann 2014, Bakitas) and meta-analyses confirmed quality-of-life and caregiver benefits; ASCO (2017, updated 2024) recommends concurrent palliative care for all patients with advanced cancer within 8 weeks of diagnosis. Delivery models include embedded clinics, telehealth (REACH PC showed video equivalent to in-person, JAMA 2024), nurse-led and primary palliative care by oncologists. The workforce gap is global: most LMICs lack access to palliative care and opioids.","status":"standard-of-care","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Palliative_care","links":[{"label":"Temel et al., early palliative care in metastatic lung cancer (NEJM 2010)","url":"https://doi.org/10.1056/NEJMoa1000678"},{"label":"ASCO guideline update 2024","url":"https://doi.org/10.1200/JCO.24.00542"},{"label":"Lancet Commission on Palliative Care 2017","url":"https://doi.org/10.1016/S0140-6736(17)32513-8"},{"label":"NHS: treatment for breast cancer in women","url":"https://www.nhs.uk/conditions/breast-cancer-in-women/treatment-for-breast-cancer-in-women/"},{"label":"Triple Negative Breast Cancer Foundation: living with metastatic TNBC","url":"https://tnbcfoundation.org/living-with-tnbc/living-with-metastatic-tnbc"},{"label":"NHS: pancreatic cancer, treatment","url":"https://www.nhs.uk/conditions/pancreatic-cancer/treatment/"},{"label":"Pancreatic Cancer UK: if you can't have surgery (inoperable cancer)","url":"https://www.pancreaticcancer.org.uk/information-and-support/just-diagnosed-with-pancreatic-cancer/if-you-cant-have-surgery-inoperable-cancer/"},{"label":"Marie Curie: what are palliative care and end of life care?","url":"https://www.mariecurie.org.uk/information/getting-care/palliative-care"},{"label":"NHS: bowel cancer, treatment","url":"https://www.nhs.uk/conditions/bowel-cancer/treatment/"},{"label":"Bowel Cancer UK: end of life care","url":"https://www.bowelcanceruk.org.uk/about-bowel-cancer/end-of-life-care/"},{"label":"Temel et al., early palliative care for patients with metastatic non-small-cell lung cancer (NEJM 2010)","url":"https://doi.org/10.1056/NEJMoa1000678"},{"label":"Marie Curie: what is palliative care?","url":"https://www.mariecurie.org.uk/information/getting-care/palliative-care"},{"label":"NICE NG122: lung cancer, palliative interventions and supportive and palliative care","url":"https://www.nice.org.uk/guidance/ng122/chapter/Palliative-interventions-and-supportive-and-palliative-care"},{"label":"NHS: treatment for lung cancer","url":"https://www.nhs.uk/conditions/lung-cancer/treatment/"},{"label":"Lymphoma Action: palliative care","url":"https://lymphoma-action.org.uk/information-and-support/lymphoma-treatment/palliative-care"},{"label":"Lymphoma Action: when lymphoma comes back, or does not respond","url":"https://lymphoma-action.org.uk/information-and-support/living-and-beyond-lymphoma/lymphoma-comes-back-relapses-or-doesnt-respond"}],"tags":["gap-fill","supportive"],"related":[],"cancers":["nsclc","pancreatic","glioblastoma","tnbc","colorectal","lung-cancer","sclc","non-hodgkin-lymphoma","dlbcl","follicular-lymphoma","mantle-cell-lymphoma","marginal-zone-lymphoma","malt-lymphoma","splenic-marginal-zone-lymphoma","nodal-marginal-zone-lymphoma","waldenstrom","primary-mediastinal-b-cell-lymphoma","burkitt-lymphoma","hodgkin-lymphoma","early-stage-classical-hodgkin-lymphoma","advanced-stage-classical-hodgkin-lymphoma","relapsed-refractory-hodgkin-lymphoma","nodular-lymphocyte-predominant-hodgkin-lymphoma","peripheral-t-cell-lymphoma","angioimmunoblastic-t-cell-lymphoma","cutaneous-t-cell-lymphoma","sezary-syndrome","primary-cns-lymphoma"],"sections":["supportive-care"],"technologies":["hospice-end-of-life","pain-management","epro-symptom-monitoring"],"targets":[],"drugs":["methylnaltrexone"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":["cicely-saunders"],"bottlenecks":[],"keyPapers":["paper-knaul-lancet","paper-sanders-j-clin-oncol"],"journals":["supportive-care-in-cancer"],"dependsOn":[],"notes":["Metastatic triple-negative breast cancer: the NHS says you will be referred to a symptom control or palliative care team and that this can help many people live a normal life for a number of years; the Triple Negative Breast Cancer Foundation advises requesting a palliative care referral as soon as the diagnosis is made, alongside treatment.","Pancreatic cancer: the NHS says people whose cancer cannot be cured are referred to the palliative care or symptom control team, which works with you to manage symptoms and helps you and your loved ones get support. Pancreatic Cancer UK says these services are not just for the end of life and are available at any point; NICE NG85 asks teams to assess the psychological impact of fatigue, pain, gut symptoms, nutrition, anxiety and depression throughout care.","Bowel cancer: the NHS says that if advanced bowel cancer cannot be cured you will be referred to a symptom control or palliative care team who help you manage symptoms, feel more comfortable and get other support for you and your loved ones. Bowel Cancer UK says palliative care may start when you are diagnosed with advanced bowel cancer or after treatment has stopped working, that its aim is to improve quality of life, and that you can choose to be cared for at home, in a hospice, in hospital or in a care home.","Lung cancer has the randomised evidence for starting palliative care early. Temel and colleagues (NEJM 2010) randomly assigned 151 people with newly diagnosed metastatic non-small-cell lung cancer to early palliative care integrated with standard oncology care or to standard oncology care alone. At 12 weeks the early palliative care group had better quality of life (mean FACT-L 98.0 against 91.5, P equals 0.03) and fewer depressive symptoms (16 against 38 percent, P equals 0.01); fewer received aggressive care at the end of life (33 against 54 percent, P equals 0.05) and median survival was longer (11.6 against 8.9 months, P equals 0.02). It is one of the few places in oncology where the supportive treatment improved survival.","The NHS says that where lung cancer cannot be cured you will be referred to a symptom control or palliative care team who help you manage symptoms, feel more comfortable and get other support for you and your loved ones. Marie Curie says palliative care can be offered at any point after a diagnosis and alongside treatments aimed at controlling the illness such as chemotherapy or radiotherapy, and that it may also support the people close to you.","Lymphoma: Lymphoma Action's palliative care page frames it as care for overall wellbeing that can run alongside treatment aimed at controlling the lymphoma, rather than as something that begins when treatment stops. Its separate material on lymphoma that comes back or does not respond covers the same ground from the other side."],"principle":"Systematic symptom assessment (ESAS, PRO-based), goals-of-care and prognostic communication (serious illness conversations), advance care planning and caregiver support delivered by a specialist team working in parallel with disease-directed treatment.","strengths":["Randomised evidence for better quality of life, mood and end-of-life care","Reduces futile treatment and hospital deaths","Telehealth delivery is equivalent to in-person"],"limitations":["Workforce shortage; referral often late or never","Perceived by patients and oncologists as 'giving up'","Opioid access absent in much of the world"],"since":1967},"route":"/technologies/palliative-care/","neighbours":{"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"anaplastic-thyroid-cancer","kind":"cancer","name":"Anaplastic thyroid cancer","route":"/cancers/anaplastic-thyroid-cancer/"},{"id":"atrt","kind":"cancer","name":"Atypical teratoid/rhabdoid tumour (ATRT)","route":"/cancers/atrt/"},{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"burkitt-lymphoma","kind":"cancer","name":"Burkitt lymphoma","route":"/cancers/burkitt-lymphoma/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"cutaneous-t-cell-lymphoma","kind":"cancer","name":"Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome)","route":"/cancers/cutaneous-t-cell-lymphoma/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"dipg-dmg","kind":"cancer","name":"Diffuse midline glioma, H3 K27-altered (including DIPG)","route":"/cancers/dipg-dmg/"},{"id":"early-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Early-stage classical Hodgkin lymphoma (stage I to II)","route":"/cancers/early-stage-classical-hodgkin-lymphoma/"},{"id":"malt-lymphoma","kind":"cancer","name":"Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)","route":"/cancers/malt-lymphoma/"},{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"gallbladder","kind":"cancer","name":"Gallbladder cancer","route":"/cancers/gallbladder/"},{"id":"glioblastoma","kind":"cancer","name":"Glioma & glioblastoma","route":"/cancers/glioblastoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"mantle-cell-lymphoma","kind":"cancer","name":"Mantle cell lymphoma","route":"/cancers/mantle-cell-lymphoma/"},{"id":"marginal-zone-lymphoma","kind":"cancer","name":"Marginal zone lymphoma","route":"/cancers/marginal-zone-lymphoma/"},{"id":"metastatic-cancer","kind":"cancer","name":"Metastatic cancer (cancer that has spread)","route":"/cancers/metastatic-cancer/"},{"id":"mycosis-fungoides","kind":"cancer","name":"Mycosis fungoides","route":"/cancers/mycosis-fungoides/"},{"id":"nodal-marginal-zone-lymphoma","kind":"cancer","name":"Nodal marginal zone lymphoma","route":"/cancers/nodal-marginal-zone-lymphoma/"},{"id":"angioimmunoblastic-t-cell-lymphoma","kind":"cancer","name":"Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma)","route":"/cancers/angioimmunoblastic-t-cell-lymphoma/"},{"id":"nodular-lymphocyte-predominant-hodgkin-lymphoma","kind":"cancer","name":"Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)","route":"/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"peripheral-t-cell-lymphoma","kind":"cancer","name":"Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)","route":"/cancers/peripheral-t-cell-lymphoma/"},{"id":"primary-cns-lymphoma","kind":"cancer","name":"Primary CNS lymphoma","route":"/cancers/primary-cns-lymphoma/"},{"id":"primary-mediastinal-b-cell-lymphoma","kind":"cancer","name":"Primary mediastinal (thymic) large B-cell lymphoma","route":"/cancers/primary-mediastinal-b-cell-lymphoma/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"relapsed-refractory-hodgkin-lymphoma","kind":"cancer","name":"Relapsed and refractory classical Hodgkin lymphoma","route":"/cancers/relapsed-refractory-hodgkin-lymphoma/"},{"id":"sezary-syndrome","kind":"cancer","name":"Sezary syndrome","route":"/cancers/sezary-syndrome/"},{"id":"skin-cancer","kind":"cancer","name":"Skin cancer (all types)","route":"/cancers/skin-cancer/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"},{"id":"splenic-marginal-zone-lymphoma","kind":"cancer","name":"Splenic marginal zone lymphoma","route":"/cancers/splenic-marginal-zone-lymphoma/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"},{"id":"waldenstrom","kind":"cancer","name":"Waldenström macroglobulinaemia","route":"/cancers/waldenstrom/"}],"section":[{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"rejuv-access-survivorship-care-nordic","kind":"technology","name":"After treatment in the Nordic countries: rehabilitation written into the pathway","route":"/technologies/rejuv-access-survivorship-care-nordic/"},{"id":"rejuv-measure-epro-as-treatment","kind":"technology","name":"Asking people how they are, every week, as a treatment in its own right","route":"/technologies/rejuv-measure-epro-as-treatment/"},{"id":"pain-management","kind":"technology","name":"Cancer pain management","route":"/technologies/pain-management/"},{"id":"rejuv-life-children-of-a-parent-with-cancer","kind":"technology","name":"Children of a parent treated for cancer","route":"/technologies/rejuv-life-children-of-a-parent-with-cancer/"},{"id":"rejuv-mind-depression-after-cancer","kind":"technology","name":"Depression during and after cancer: the interview-based prevalence, and the care model that works","route":"/technologies/rejuv-mind-depression-after-cancer/"},{"id":"epro-symptom-monitoring","kind":"technology","name":"Electronic patient-reported outcome (ePRO) symptom monitoring","route":"/technologies/epro-symptom-monitoring/"},{"id":"enteral-parenteral-nutrition","kind":"technology","name":"Enteral and parenteral nutrition support","route":"/technologies/enteral-parenteral-nutrition/"},{"id":"global-oncology-access","kind":"technology","name":"Global oncology and access in low- and middle-income countries","route":"/technologies/global-oncology-access/"},{"id":"hospice-end-of-life","kind":"technology","name":"Hospice and end-of-life care","route":"/technologies/hospice-end-of-life/"},{"id":"massage-therapy-cancer","kind":"technology","name":"Massage therapy in cancer care","route":"/technologies/massage-therapy-cancer/"},{"id":"music-therapy-cancer","kind":"technology","name":"Music therapy and music medicine","route":"/technologies/music-therapy-cancer/"},{"id":"oncology-nursing","kind":"technology","name":"Oncology nursing and nurse-led care","route":"/technologies/oncology-nursing/"},{"id":"psycho-oncology","kind":"technology","name":"Psycho-oncology and distress screening","route":"/technologies/psycho-oncology/"},{"id":"rejuv-mind-sleeping-tablets-after-cancer","kind":"technology","name":"Sleeping tablets after cancer: what they do and what they do not","route":"/technologies/rejuv-mind-sleeping-tablets-after-cancer/"},{"id":"smoking-cessation-after-diagnosis","kind":"technology","name":"Smoking cessation in cancer patients","route":"/technologies/smoking-cessation-after-diagnosis/"},{"id":"telehealth-oncology","kind":"technology","name":"Telehealth and hospital-at-home in oncology","route":"/technologies/telehealth-oncology/"},{"id":"rejuv-life-carers","kind":"technology","name":"The carer's own recovery: what is known about the person who is not the patient","route":"/technologies/rejuv-life-carers/"}],"drug":[{"id":"methylnaltrexone","kind":"drug","name":"Methylnaltrexone","route":"/drugs/methylnaltrexone/"},{"id":"samarium-153-lexidronam","kind":"drug","name":"Samarium-153 lexidronam","route":"/drugs/samarium-153-lexidronam/"},{"id":"talc-sclerosant","kind":"drug","name":"Talc (intrapleural)","route":"/drugs/talc-sclerosant/"}],"person":[{"id":"cicely-saunders","kind":"person","name":"Dame Cicely Saunders","route":"/people/cicely-saunders/"},{"id":"kate-granger","kind":"person","name":"Kate Granger","route":"/people/kate-granger/"},{"id":"li-ka-shing","kind":"person","name":"Li Ka-shing","route":"/people/li-ka-shing/"},{"id":"ratan-tata","kind":"person","name":"Ratan Tata","route":"/people/ratan-tata/"}],"paper":[{"id":"paper-knaul-lancet","kind":"paper","name":"Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report","route":"/key-papers/paper-knaul-lancet/"},{"id":"paper-sanders-j-clin-oncol","kind":"paper","name":"Palliative Care for Patients With Cancer: ASCO Guideline Update","route":"/key-papers/paper-sanders-j-clin-oncol/"},{"id":"paper-temel-early-palliative-care-nejm-2010","kind":"paper","name":"Temel: early palliative care alongside chemotherapy improved quality of life, mood and survival in lung cancer","route":"/key-papers/paper-temel-early-palliative-care-nejm-2010/"}],"journal":[{"id":"supportive-care-in-cancer","kind":"journal","name":"Supportive care in cancer","route":"/journals/supportive-care-in-cancer/"}],"term":[{"id":"coeliac-plexus-block","kind":"term","name":"Coeliac plexus block for pancreatic cancer pain","route":"/terms/coeliac-plexus-block/"},{"id":"curative-intent","kind":"term","name":"Curative intent vs palliative intent","route":"/terms/curative-intent/"},{"id":"duodenal-stenting-gastric-outlet","kind":"term","name":"Duodenal stenting and gastrojejunostomy for malignant gastric outlet obstruction","route":"/terms/duodenal-stenting-gastric-outlet/"},{"id":"emotional-support-cancer-uk","kind":"term","name":"Emotional support and helplines (UK)","route":"/terms/emotional-support-cancer-uk/"},{"id":"pain-with-biliary-cancer","kind":"term","name":"Pain with gallbladder and bile duct cancer","route":"/terms/pain-with-biliary-cancer/"},{"id":"tnbc-symptom-control-palliation","kind":"term","name":"Palliation in advanced triple-negative breast cancer: brain, bone, pleura, skin and end of life","route":"/terms/tnbc-symptom-control-palliation/"},{"id":"colorectal-palliation-obstruction-pain","kind":"term","name":"Palliation in colorectal cancer: obstruction, stents, stomas and liver capsule pain","route":"/terms/colorectal-palliation-obstruction-pain/"},{"id":"lung-palliation-breathlessness-effusion-obstruction","kind":"term","name":"Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain","route":"/terms/lung-palliation-breathlessness-effusion-obstruction/"},{"id":"pancreatic-palliation-obstruction-pain-nutrition","kind":"term","name":"Palliation in pancreatic cancer: biliary and duodenal stents, coeliac plexus block, enzymes and cachexia","route":"/terms/pancreatic-palliation-obstruction-pain-nutrition/"},{"id":"palliative-treatment","kind":"term","name":"Palliative","route":"/terms/palliative-treatment/"},{"id":"gallbladder-cancer-symptom-control","kind":"term","name":"Symptom control in advanced gallbladder cancer: pain, ascites and nutrition","route":"/terms/gallbladder-cancer-symptom-control/"}],"trial":[{"id":"ample","kind":"trial","name":"AMPLE","route":"/trials/ample/"},{"id":"quartz","kind":"trial","name":"QUARTZ","route":"/trials/quartz/"},{"id":"time2","kind":"trial","name":"TIME2","route":"/trials/time2/"}],"target":[{"id":"oprm1","kind":"target","name":"Mu-opioid receptor","route":"/targets/oprm1/"}],"institution":[{"id":"cmc-vellore","kind":"institution","name":"Christian Medical College, Vellore","route":"/institutions/cmc-vellore/"},{"id":"li-ka-shing-foundation","kind":"institution","name":"Li Ka Shing Foundation","route":"/institutions/li-ka-shing-foundation/"}],"roadmap":[{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"}]}}