Should early referral to palliative care be standard of care for all patients with metastatic cancer?

There are data to support that early palliative care involvement can improve patient quality of life. One study that specifically comes to mind is a study published by Temel et al in NEJM 2010 (http://www.ncbi.nlm.nih.gov/pubmed/20818875) in the setting of metastatic NSCLC. This study randomized patients between early palliative care vs standard care, and showed improved QoL, mood, and even survival in patients involved early with palliative care. Interesting data, especially from the survival s...

I certainly agree that ideally, it would indeed be most valuable for patients to have these conversations (illness understanding, coping, other) when they are at their best PS and health. Unfortunately, the available field of palliative care practioners is not large enough to meet this ideal. Much emphasis is therefore on primary palliative medicine, eg, that given by the primary oncology team (usually med onc, but rad onc and surg onc would count as well). Quill and Abernethy have a good Perspe...

I agree with @Dr. First Last. While there is a great deal of momentum towards the early integration of palliative care (with endorsement of this idea by the Institute of Medicine, ASCO, and others), there are too few palliative care specialists and teams to make this a scalable solution. It is estimated that there are fewer than 7000 palliative care specialists in the U.S. The way forward is more likely to involve improving the delivery of primary palliative care, with alternative payment models...