Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care.

/pdf/integration-of-oncology-and-palliative-care-a-lancet-1gya2zwql0.pdf

Integration of oncology and palliative care: a Lancet Oncology Commission

Background:In the context of limited resources, evidence on costs and cost-effectiveness of alternative methods of delivering health-care services is increasingly important to facilitate appropriate resource allocation. Palliative care services have been expanding worldwide with the aim of improving the experience of patients with terminal illness at the end of life through better symptom control, coordination of care and improved communication between professionals and the patient and family.Aim:To present results from a comprehensive literature review of available international evidence on the costs and cost-effectiveness of palliative care interventions in any setting (e.g. hospital-based, home-based and hospice care) over the period 2002–2011.Design:Key bibliographic and review databases were searched. Quality of retrieved papers was assessed against a set of 31 indicators developed for this review.Data Sources:PubMed, EURONHEED, the Applied Social Sciences Index and the Cochrane library of databases....

https://journals.sagepub.com/doi/pdf/10.1177/0269216313493466

Evidence on the cost and cost-effectiveness of palliative care: A literature review:

Pivodic et al 1 provide important new insight into place of death both cross-nationally and for different diagnostic groups. Their analysis of death certificate data in 15 countries reveals important evidence to inform end-of-life policy, as only between 13% and 25% died at home; 25–85% died in hospital. Given the broad preference for home death in the literature, and lower costs of home death, the authors rightly call for improved health policy in this field.

Their use of cross-national death certificate data …

https://jech.bmj.com/content/jech/70/1/17.full.pdf

Place of death in the population dying from diseases indicative of palliative care need: a cross-national population-level study in 14 countries

and Political Science is a leading social care research group. Since its establishment in 1974 at the University of Kent, PSSRU has had considerable impact on national social care and mental health policy and practice in the UK and in a number of other countries. This report presents an independent review commissioned by Marie Curie. The views expressed in this publication are those of the authors and not necessarily those of the funder. was commissioned by Marie Curie to explore the evidence on equity in palliative care and to consider the economic implications of extending palliative care to those currently under-served. This report presents the findings from a wide-ranging and comprehensive review of research literature and nationally available data, and new multivariate analyses of data from the National Survey of Bereaved People in England, 2013. Palliative care aims to ensure the best possible quality of life for people in advanced illness and at end of life, and for their families, by actively managing pain and other symptoms and providing psychological, social and spiritual support. Palliative care may be delivered by specially trained, multidisciplinary specialists teams or by generalist providers such as GPs, district nurses, hospital doctors and nurses, allied health professionals, care home staff, social care staff, social workers, chaplains and others, who have not received accredited training in palliative care but routinely care for people with advanced illness or at end of life. Modern palliative care began with the hospice movement, although the initial focus on providing care to cancer patients and reliance on charitable funding meant that provision was thinly and inequitably spread. Despite steps to extend specialist palliative care, inequities in provision have persisted. The importance of addressing these inequities is recognised in national end of life care the need for palliative care is fast increasing as the population ages, particularly amongst those with non-cancer diagnoses, with the numbers of people aged 85 or over, for example, expected to more than double by 2037 in all four UK countries. We found important differences in data availability in each of the four UK countries. The National Survey of Bereaved People in England contributed a considerable amount of the evidence used in our review and is a rich source of representative data on access to, and experiences of, end of life and palliative care. However, no similar survey is undertaken in Wales, Northern Ireland or Scotland, leading to gaps …

Equity in the provision of palliative care in the UK: review of evidence

Health care commissioners will need to deliver a sustainable system in the face of the most challenging financial and organisational environment seen in decades. This document, from The King’s Fund, sets out ten priorities for action to help commissioners transform the health care system. The paper was originally published in March 2011. It was last updated in June 2015 to reflect changes in the NHS.

https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/transforming-health-care-system-ten-priorities-commissioners-may11.pdf

Transforming our health care system: ten priorities for commissioners

: This report was prepared for and in collaboration with the National Audit Office. The study objective was twofold: first, to provide an estimation of the current economic impact of caring for patients during their last year of life in England; and, second, to simulate the potential benefits of an expansion of those services by decreasing reliance on acute care during that time. The study is part of a broader Value for Money study that the UK NAO is undertaking into end of life care in England. Our study comprised of a review of the existing literature on palliative and end of life care and the development of a Markov model using health expenditures and utilisation data. We used the model to estimate current costs to the NHS of end of life care for cancer and organ failure "heart and respiratory" patients and, to measure cost implications of various scenarios of expanding home/community end of life services. We linked potential reductions in emergency admissions and length of stay to those services. Sensitivity analysis examined factors exerting influence in the overall costs of end of life care. The report will be of interest to healthcare providers and policymakers who seek a more clear understanding of the economics of end of life care. Overall, the study results consistently point in the same direction as the literature: there is real potential for end of life services to reduce expenditures associated with hospitalisations while at the same time accommodating the expressed preferences of patients.

/pdf/the-potential-cost-savings-of-greater-use-of-home-and-v9nw0mtpz7.pdf

The potential cost savings of greater use of home- and hospice- based end of life care in England

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The potential cost savings of greater use of home- and hospice- based end of life care in England