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Michael H. Levy, Anthony Back, Costantino Benedetti, J. Andrew Billings, Susan Block, Barry Boston, Eduardo Bruera, Sydney Dy, Catherine Eberle, Kathleen M. Foley, Sloan Beth Karver, Sara J. Knight, Sumathi Misra, Christine S. Ritchie, David Spiegel, Linda Sutton, Susan Urba, Jamie H. Von Roenn and Sharon M. Weinstein

Palliative Care Clinical Practice Guidelines in Oncology NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Overview Palliative care is both a philosophy of care and an organized, highly structured system for delivering care to persons with life-threatening or debilitating illness. Palliative care is patient- and family-centered care that focuses on effective management of pain and other distressing symptoms, while incorporating psychosocial and spiritual care according to patient/family needs, values, beliefs, and cultures. The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of disease stage or the need for other therapies. Palliative care can be delivered concurrently with life-prolonging care or as the main focus of care. The standards of palliative care are as follows: • Institutions should develop a process ensuring that all patients have access to palliative care services from the initial visit....
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Jimmie C. Holland, Barbara Andersen, William S. Breitbart, Bruce Compas, Moreen M. Dudley, Stewart Fleishman, Caryl D. Fulcher, Donna B. Greenberg, Carl B. Greiner, George F. Handzo, Laura Hoofring, Paul B. Jacobsen, Sara J. Knight, Kate Learson, Michael H. Levy, Matthew J. Loscalzo, Sharon Manne, Randi McAllister-Black, Michelle B. Riba, Kristin Roper, Alan D. Valentine, Lynne I. Wagner and Michael A. Zevon

Overview In the United States, a total of 1,479,350 new cancer cases and 562,340 deaths from cancer were estimated to occur in 2009. 1 All patients experience some level of distress associated with the diagnosis and treatment of cancer at all stages of the disease. Surveys have found that 20% to 40% of patients with newly diagnosed and recurrent cancer show a significant level of distress. 2 However, fewer than 10% are actually identified and referred for psychosocial help. 3 Many cancer patients who are in need of psychosocial care are not able to get the help they need due to the under recognition of patient's psychological needs by the primary oncology team and lack of knowledge of community resources. The need is particularly acute in community oncology practices that have few to no psychosocial resources, and cancer care is often provided in short visits. 4 For many centuries, patients were not told their diagnosis of cancer because of the stigma attached to the disease. Since the 1970s, this situation has changed and patients are well aware of their diagnosis and treatment options. However, patients are reluctant to reveal emotional problems to the oncologist. The words psychological, psychiatric, and emotional are as stigmatizing as cancer. Psychological issues remain stigmatized even in the context of coping with cancer. Consequently, patients often do not tell their physicians about their distress and physicians do not inquire about the psychological concerns of their patients. Recognition of patients' distress has become more difficult as cancer care has shifted to the...
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Michael H. Levy, Michael D. Adolph, Anthony Back, Susan Block, Shirley N. Codada, Shalini Dalal, Teresa L. Deshields, Elisabeth Dexter, Sydney M. Dy, Sara J. Knight, Sumathi Misra, Christine S. Ritchie, Todd M. Sauer, Thomas Smith, David Spiegel, Linda Sutton, Robert M. Taylor, Jennifer Temel, Jay Thomas, Roma Tickoo, Susan G. Urba, Jamie H. Von Roenn, Joseph L. Weems, Sharon M. Weinstein, Deborah A. Freedman-Cass and Mary Anne Bergman

These guidelines were developed and updated by an interdisciplinary group of experts based on clinical experience and available scientific evidence. The goal of these guidelines is to help patients with cancer experience the best quality of life possible throughout the illness trajectory by providing guidance for the primary oncology team for symptom screening, assessment, palliative care interventions, reassessment, and afterdeath care. Palliative care should be initiated by the primary oncology team and augmented by collaboration with an interdisciplinary team of palliative care experts.