Palliative Care: If It Makes a Difference, Why Wait?

With prognostic indicators at hand, toss a coin. Half of all patients with cancer might be predicted to die as a result of the disease within 5 years. Ask yourself whether an individual patient might die within a year, and you are likely to be incorrect in your estimate. But what is certain is that you will not be able to cure everyone. Palliative care offers patients and (note) their families a comprehensivepackageofcarebyateamofprofessionalswhobecameexperts in solving the difficult and multiple symptoms and problems that usually arise in advanced stages of the disease, helping to achieve comfort and eventually a peaceful death and bereavement. The practice has matured during the last 50 years, and it can be provided together with curative treatment. There are approximately 16,000 palliativecareservicesworldwide, 1 andfast-growingresearchdemonstrates the effectiveness of interventions, most notably that of homebasedmodelsofpalliativecaretosupportpatientsintheirownhomes, which is where most would prefer to be cared for and die, with family nearby. 2 In2012,afterpublicationofstrongevidencefromaphaseIII randomized controlled trial (RCT), 3 an American Society of Clinical Oncology provisional clinical opinion recommended consideration of combined standard oncology care and palliative care early in the course of illness for any patient with metastatic cancer and/or a high symptom burden. 4 In 2014, a landmark resolution was passed unanimously at the World Health Assembly that called for all state members to strengthen palliative care as a component of integrated treatment within the continuum of care. 5 The question of when to