Plenary lecture: Early integration of palliative care – Irene Higginson, Cicely Saunders Institute, King’s College London, UK

12:00-12:40

Room: Hall 1A

The World Health Organization recommends that palliative care is “applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.” However, it many instances palliative care is offered later in the course of illness, or only in advanced cancer, although this varies internationally. Cancer has changed in recent decades, blurring the interfaces between curative, life prolonging and life enhancing. It will change more in the future. This has led to new international approaches to palliative care.

A 2017 Cochrane meta-analysis found that early palliative care may have more beneficial effects on quality of life and symptom intensity among patients with advanced cancer than among those who receive usual/standard cancer care alone, although many of the studies were small. Since then studies continue to emerge. However, what does ‘advanced cancer’ mean? What does ‘early’ mean? Can palliative care be offered when the cancer is likely to be cured if symptoms or other problems are especially problematic, as is common for example in some haematological cancers? Should it be the clinicians’ responsibility to decide when palliative care is needed? Or can there be more systematic approaches. What model of palliative care is appropriate – integrated, co-ordinating? How are the terms palliative care and palliative medicine introduced? Does palliative care have a role in phase I trials.

In this plenary I will consider the above questions in the light of the latest evidence of the cost-effectiveness of early palliative care, the outcomes that such interventions might achieve, potential new referral criteria, and implications for practice, workforce, person-centred care and patient awareness and self-management.