Consolidation of the use of early palliative care in cancer patients: rationale and barriers. a review of the literature

Background: One of the most controversial aspects of modern palliative care is the correct integration with the standard therapies aimed to neoplasia treatment. As outlined by the World Health Organization (WHO), palliative care should be applied to improve the quality of life of all patients with life-threatening disease and their family, and should start during the treatments intended to prolong life and be extended as a continuum care throughout the course of the disease and not limited to the terminal end-of-life period. Despite this assertion and although palliative care services are rapidly increasing worldwide, it is well known that patients diagnosed with cancer in advanced stage, continue to be sent to palliative care too late, thus resulting in an inadequate and inhomogeneous use of these therapies. The aim of our review of literature has been to identify and analyse in depth the rationale of early palliative care in cancer patients and the main barriers hindering its use. Materials and methods: The research has been carried out consulting the MEDLINE database since January 1970 to October 2014, inputting the terms “early”, “palliative”, “care”,“palliative care”, “palliation”. The application of broader selection criteria has been due to the assumption of a high sensitivity in primary research, at the expense of a low specificity, that was then improved during the analysis of the various works. We have analysed the abstracts sorted out through the search string, selecting the articles available both in English and Italian, deemed potentially useful to the review. Results: Our review has detected and explored four main achievable goals, through the use of concurrent palliative oncology care: improving the control of physical and psychological symptoms, improving the communication of prognosis and the decision-making process, the proper use of resources and the improvement of survival, as a further potential achievable goal, resulting from the upgraded quality of life. The main barriers identified and analysed have been classified as terminological, communicative, methodological, psychological and cultural, resource-related and organizational. Conclusions: This review of the literature outlines that there is a strong rationale for the consolidation of early palliative care in patients with advanced cancer state and highlights the barriers to overcome to reach this important goal.