Supporting the journey: palliative care for patients with gastrointestinal cancers
Cancers of the gastrointestinal (GI) tract include malignancies of the esophagus, stomach, pancreas, liver, biliary tract, small intestines, colon and anus and represent a major global health challenge. GI cancers collectively account for more than four million new cancer diagnoses and over three million deaths annually, according to the most recent GLOBOCAN estimates (1). This represents a substantial proportion of global cancer mortality. Colorectal, gastric, hepatic, and pancreatic cancers rank among the top causes of cancer-related death worldwide (2).
GI malignancies create some of the most complex encounters in oncology. These cancers cause significant symptom burden, may be unpredictable with rapid disease progression, and create profound psychosocial impacts on the individual patient, families and their support networks. While advances in screening, surgical techniques, and systemic therapies have had major benefits in treatment and longevity, patients continue to be diagnosed with GI malignancies at advanced disease stage, leaving them with limited or no curative options, as well as a disease trajectory that is marked by complex and burdensome symptoms.
The GI cancers cause a plethora of physical symptoms: pain, nausea, vomiting, dysphagia, jaundice, ascites, bleeding, fatigue, cachexia, obstruction, malnutrition, weakness, diarrhea and constipation. Moreover, there are serious psychosocial and spiritual symptoms as well: depression, anxiety, insomnia, fatigue, existential distress, food aversion, image and identity dysfunction. The combination of physical and psychological symptoms, together with the toxicities of treatments and medical complications that can occur, including GI and hepatic dysfunction can lead to progressive functional decline and treatment intolerance.
Aggressive tumor biology is common in GI malignancies, particularly in pancreatic adenocarcinoma and cholangiocarcinoma, and this may lead to rapid disease progression before effective intervention is possible. Patients and families struggle deeply when disease burden and state at diagnosis, as well as functional status preclude attempting cancer treatment, and this is more common among GI malignancies than other types of cancers. Even when chemotherapy or targeted therapy is pursued, survival benefits are typically measured in months not years and potential benefits must be weighed against treatment-related toxicities for metastatic GI cancers other than stage IV colorectal cancer and some rare subgroups of patients in other cancer.
Because of the challenges of treatment and burdens of disease, addressing symptoms comprehensively, supporting emotional well-being, and aligning treatment plans with individual patient goals and values is critical in caring for patients with GI cancers. Early and consistent integration of palliative care alongside disease-directed therapy provides this type of comprehensive, patient-centered care. Palliative care for patients with GI malignancies is crucial and extends far beyond end-of-life care; it includes alleviating symptoms, optimizing quality of life, supporting decision-making, and addressing the emotional, spiritual, and social needs of patients and their families to allow them to live as well and as long as possible in the face of serious illness. In the context of GI cancers, where disease progression can be unpredictable and treatment often entails a delicate balance between potential benefits and substantial harms and toxicities, palliative care providers play a pivotal role in guiding therapeutic choices, managing complex symptoms to allow for best possible treatment adherence, and facilitating transitions in goals of care.
Caregivers carry a heavy burden, navigating both the emotional demands and the practical responsibilities of care, and they are often overlooked as the focus of care is so heavily oriented toward the physical needs of the patient. Palliative care providers, however, are trained to assess the needs of the caregivers of patients and can provide assistance within the scope of their practice and connect caregivers with additional and targeted support when needed.
GI cancers are particularly challenging for medical providers involved in their care. Patients die at high rates and may have painful and burdensome end-of-life courses. Repeatedly caring for patients like this can be demoralizing for providers and can lead to emotional exhaustion and burnout. Palliative care offers another option to support the patients and families, leading to less chaos and distress at end of life, and thus also supports the medical providers both directly and indirectly.
Despite its known value and well documented utility, palliative care remains underutilized in GI oncology. Common barriers include persistent misconceptions among both patients and clinicians about the role of palliative care. Many oncologists continue to view palliative care as synonymous with hospice and perceive that consulting a palliative care provider means giving up on their patient. Other barriers include time constraints, prognostic uncertainty, and discomfort with end-of-life conversations on the part of the oncology providers.
Problematically, the need for palliative care providers outpaces the available resources. According to the Center to Advance Palliative Care, there are 19,920 health care professions (including physicians, nurses, advanced practice providers, social workers, and chaplains) in the U.S. who are certificated or have completed advanced qualification in hospice and palliative care (3). While the palliative care workforce has grown in the past two decades, it remains vastly insufficient to meet the needs of the more than 13 million seriously ill Americans. Moreover, more than half of adults in the US report one chronic health condition, so the number of potential individuals who would benefit from palliative care services is vastly underestimated.
In 2010, Temel et al. (4) published the landmark trial that forever changed the understanding of palliative care in oncology. That study demonstrated that early palliative care improved quality of life, reduced depressive symptoms, and was associated with longer survival in patients with non-small cell lung cancer. Since that time, the body of literature establishing the value of palliative care for patients with numerous illnesses, including GI cancers, has continued to grow. That seminal article and the work of numerous researchers and clinicians since then, has led to the recognition that palliative care should be provided alongside disease-directed therapy rather than waiting until all other possibilities for treatment have been exhausted.
This series of articles explores the principles, timing, and implementation of palliative care in GI malignancies, with a focus on its impact on symptom burden, quality of life, and patient outcomes. By highlighting both the evidence base and practical considerations, the review aims to underscore the necessity of integrating palliative care as a standard of care in the management of these challenging diseases and how doing so earlier in the disease process offers more opportunity to have meaningful impact on patients, family, providers and communities.
Integrating palliative care early and consistently—through a multidisciplinary, culturally sensitive and comprehensive approach—offers the best opportunity to relieve suffering, maintain dignity, and ensure that care aligns with the values and priorities of each individual person and their support networks.
Acknowledgments
None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine, for the series “Palliative Care in GI Malignancies”. The article did not undergo external peer review.
Funding: None.
Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-25-105/coif). The series “Palliative Care in GI Malignancies” was commissioned by the editorial office without any funding or sponsorship. K.A. served as the unpaid Guest Editor of the series. The authors have no other conflicts of interest to declare.
Ethical Statement: The authors are 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
- Filho AM, Laversanne M, Ferlay J, et al. The GLOBOCAN 2022 cancer estimates: Data sources, methods, and a snapshot of the cancer burden worldwide. Int J Cancer 2025;156:1336-46. [Crossref] [PubMed]
- Arnold M, Abnet CC, Neale RE, et al. Global Burden of 5 Major Types of Gastrointestinal Cancer. Gastroenterology 2020;159:335-349.e15. [Crossref] [PubMed]
- Available online: https://www.capc.org/capc-reports-and-publications/
- 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]
