The evolution of palliative medicine and its integration with oncology care

The November 2023 issues of Annals of Palliative Medicine featured 3 Editorials, 5 Original Articles, 19 Review Articles, 3 Editorial Commentary Articles, and 1 Case Report, along with 3 Letters to the Editor.

One of the Editorials (1), commissioned by Editorial Office, critically reexamines the scope of Annals of Palliative Medicine based on a review of the disciplinary development and evolving definition of palliative medicine. While Annals of Palliative Medicine has always focused since its inception on providing up-to-date and cutting-edge information and professional support for health care providers in palliative medicine disciplines to improve the quality of life for patients and their families and caregivers (2), the discipline of palliative medicine has evolved considerable since the first printed issue of the journal in 2012. This Editorial is a highly educational read and discusses the history of palliative medicine and then critically considers the definition of palliative medicine in the contact of varying existing definitions by major medical and other governing bodies. Next, Zhang and colleagues (1) discuss how palliative medicine, palliative care, hospice care, supportive care, and public health palliative care are related.

With such a critical assessment and the most up-to-date analysis of the definition of palliative medicine currently available, the authors then reassess the scope of Annals of Palliative Medicine. Recognizing a broad scope of palliative medicine, they defined eight primary focuses of scope for the journal to provide clearer guidance to authors, reviewers, readers, reviewers, and editors as follows (1):

• Palliative medicine and palliative care for incurable cancer;
• Palliative medicine and palliative care for serious or advanced diseases;
• Symptom management in palliative medicine and palliative care;
• Psychiatric, psychological, social, and spiritual issues in palliative medicine and palliative care;
• Public health in palliative medicine and palliative care;
• Teamwork and education in palliative medicine and palliative care;
• Ethics and policy in palliative medicine and palliative care;
• Communication in palliative medicine and palliative care.

Reading this comprehensive Editorial, it is quite clear that palliative medicine has developed into a discipline with a broad scope, encompasses patients from hospice care to those with supportive care needs, and includes palliative care at all stages of various serious and life-threatening diseases and end-of-life situations. Editorial workflow improvements are also discussed, as is a commitment of Annals of Palliative Medicine to continually reassess the scope of palliative medicine and its increasing emphasis on symptom management and supportive care to best serve the needs of its readers and of palliative care and more expanded healthcare providers who rely on its content to inform them on how to provide the most optimal care for their patients (1).

Furthermore, the November 2023 journal issue had a preponderance of oncology articles, with 4 of the 5 Original Articles and 16 of the 19 Review Articles focusing on oncology care in the palliative setting. The integration of palliative care with oncology care is a critical element of management in patients with advanced presentations of cancer, and it is a primary focus of this journal, as detailed above. As such, the remainder of this Message from the Editor-in-Chief will focus on one Review Article that discusses this integration between palliative care and oncology and provides commentary on the path ahead and optimizing this integration.

Caglayan and colleagues from the United Kingdom detail how both the healthcare environment and the oncology treatment landscape have become progressively more intricate, necessitating providers caring for patients with cancer to become increasingly well versed in the best way to integrate palliative care with cancer care (3). Furthermore, the psychosocial care needs of patients with advanced cancers and their families are often distinct and influence management approaches. The authors describe the key elements of palliative care delivery and focus on early integration of palliative care in the comprehensive management of patients with advanced malignancies. Such early integration of palliative care for these patients has been widely reported in Annals of Palliative Medicine even since the first issues of this journal (4-6) as a means of better improving patient quality of life, symptom control, and patient and provider satisfaction. Such early integration can also reduce aggressive care at the end of life, increase rates of completing advanced directives, reduce hospitalizations, and shorten hospital lengths of stay, all of which can serve to reduce medical costs (7,8). Additionally, in select scenarios, such early integration of palliative care can also significantly improve patient survival (9,10).

Caglayan and colleagues discuss the optimal timing of the referral to patient care for patients with advanced malignancies and what the optimal model for service delivery is for these patients. They also describe barriers—from education to resource availability—commonly encountered in the early integration of palliative care, and they provide solutions for these challenges that are potentially deliverable both in a nationalized medical system, such as the National Health Service in England, as well as other privatized models of healthcare. They conclude with a strong call for palliative care to be considered an essential component of early management for patients with advanced malignancies rather than something to be introduced when systemic therapies, radiation therapy, and surgical treatment options have been exhausted (3).

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-24-23/coif). The author serves as Editor-in-Chief of Annals of Palliative Medicine. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Zhang K, Shang B, Kellehear A, et al. Scope of Annals of Palliative Medicine based on a review of the disciplinary development and evolving definition of palliative medicine. Ann Palliat Med 2023;12:1125-31. [Crossref] [PubMed]
2. Simone CB 2nd. Current focus and future advances for Annals of Palliative Medicine. Ann Palliat Med 2014;3:37-8. [PubMed]
3. Caglayan A, Redmond S, Rai S, et al. The integration of palliative care with oncology: the path ahead. Ann Palliat Med 2023;12:1373-81. [Crossref] [PubMed]
4. Nieder C, Norum J. Early palliative care in patients with metastatic non-small cell lung cancer. Ann Palliat Med 2012;1:84-6. [PubMed]
5. Gaertner J, Lutz S, Chow E. Early palliative care: philosophy vs. reality. Ann Palliat Med 2015;4:87-8. [PubMed]
6. Zhi WI, Smith TJ. Early integration of palliative care into oncology: evidence, challenges and barriers. Ann Palliat Med 2015;4:122-31. [PubMed]
7. Davis MP, Temel JS, Balboni T, et al. A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses. Ann Palliat Med 2015;4:99-121. [PubMed]
8. Simone CB 2nd. Early palliative care and integration of palliative care models in modern oncology practices. Ann Palliat Med 2015;4:84-6. [PubMed]
9. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733-42. [Crossref] [PubMed]
10. Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 2014;383:1721-30. [Crossref] [PubMed]