Early Integration of Palliative and Oncological Care: Con

Abstract

For almost a decade, 'early integration' has become a buzzword in the palliative care community. Can this still be an issue of controversy? The goals of care in palliative medicine are beyond any criticism and in fact should be, at least in theory, goals of good oncological care. However, the reality presents a different picture. The care of cancer patients requires improvement, and the studies on the early integration of palliative care (EIPC) reveal deficits in the oncological practice. However, the limitations and methodological weaknesses of these EIPC studies are insufficiently analyzed and discussed. The main criticisms relate to the incomplete definition of primary endpoints, published analyses deviating from the study protocols and insufficient consideration for multiple testing. If this criticism is justified, a possible consequence would be to overrate the achievable effects of EIPC and to limit the use of these studies in guiding policies. Improving the care of cancer patients by fostering their primary care by oncologists could provide one of the alternative approaches, but needs to be evaluated in future studies. Unmet needs in physical, psychic, spiritual or social care need to be addressed. Whether this requires a multiprofessional team in all cases is another issue of discussion.

Keywords: Early Palliative Care; Early integration; Patient reported outcomes; Specialist Palliative Care.