Palliative care is increasingly seen as a standard component of high-quality, patient-centered comprehensive cancer care. In early 2012, ASCO released its pivotal “provisional clinical opinion” (PCO) statement on this topic, recommending the integration of specialist palliative care services into standard cancer care for those with metastatic or advanced disease, from the time of diagnosis.1 This opinion was rendered in light of newly published practice-changing data from a randomized controlled trial of palliative care in advanced lung cancer that showed improvements in quality of life and survival.2 The PCO reinforced to the oncology community that palliative care is not synonymous with end-of-life care, and that specialist palliative care services constitute a specific high-level skillset that adds something important to the care of patients with advanced cancers or those who have a significant symptom burden.
Although the PCO represents a giant leap forward for patients with cancer and their families, several challenges remain to its implementation. First, being a relatively young medical specialty, palliative medicine faces significant workforce problems. Simply not enough palliative care clinicians are practicing and available to see all the patients who should be seen under the PCO rubric; a recent task force from the American Academy of Hospice and Palliative Medicine (AAHPM) projects a shortage of more than 6000 full-time physicians in the field.3 Second, major reimbursement barriers remain. The lack of an established reimbursement mechanism for outpatient palliative care, for example, can make starting a clinic difficult even when it is clearly needed. Third, being a young field, palliative medicine has a relatively limited evidence base to guide interventions and practice.
This article focuses on the issue of evidence base development in palliative cancer care, using the example of a recently published randomized controlled trial of a commonly used palliative intervention to highlight the importance and need for rigorous clinical trials in this space.
Dr. LeBlanc has disclosed that he is the recipient of a Junior Career Development Award from the National Palliative Care Research Center. Dr. Abernethy had disclosed that she has received research funding from the National Institute of Nursing Research; NCI; Agency for Healthcare Research and Quality; DARA BioSciences, Inc.; GlaxoSmithKline; Celgene Corporation; Helsinn Therapeutics, Inc.; Dendreon Corporation; KangLaiTe USA; Bristol-Myers Squibb Company; and Pfizer Inc.; these funds are all distributed to Duke University Medical Center to support research including salary support for Dr. Abernethy. Pending industry-funded projects include: Galena Biopharma and Insys Therapeutics, Inc. Since 2012, she has had consulting agreements with or received honoraria from Bristol-Myers Squibb Company and ACORN Research, LLC. Dr. Abernethy has corporate leadership responsibility in athenahealth, Inc., Advoset, and Orange Leaf Associates, LLC. She is pending employment with Flatiron Health.
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