To what degree is palliative care integrated in guidelines and pathways for adult cancer patients in Europe: a systematic literature review: Beyond the Abstract

The European Society of Medical Oncology (ESMO) and various other oncological associations (such as ASCO and NCCN) recommend that palliative care (PC) should be integrated alongside cancer treatment in the disease trajectory [1-4]. There is increasing evidence that early integration of PC for patients with cancer improves quality of life, leads to better patient and caregiver outcomes, improves symptoms and patient satisfaction, reduces caregiver burden, and reduces the use of futile interventions. 

In this systematic review we examined the extent of palliative care integration in guidelines and pathways for cancer patients [5]. Our results revealed that the level of integration of PC in cancer guidelines in Europe is moderate with referral criteria being the least well defined. Even though the illness trajectory for cancer is fairly well understood, several studies indicate that available referral criteria are either too general or too difficult to implement into clinical practice. In addition, it is observed that there is little attention paid to the “early” integration of PC. 

As a next step, we extended our review to examine guidelines developed and published by the European Society for Medical Oncology (ESMO) [1]. In this ongoing study, we found that the majority of cancer guidelines focused on reducing the physical suffering  of the patients and did not provide any other information on how to integrate PC. The level of PC integration was considered very low for the  guidelines screened and there was no reference to when PC should be initiated. However our analysis revealed one guideline that corresponded to a high level of PC integration [6]. This guideline could be used as a benchmark for the development of future guidelines. 

Written by: Van Beek K, Siouta N, Payne S, Hasselaar J

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  1. European Society for Medical Oncology (ESMO) Palliative Care Working Group. Available at: (accessed 06-01-2014).
  2. American Society of Clinical Oncology (ASCO). Palliative Care in Oncology. (accessed 14-10-2016)
  3. Levy MH, Back A, Benedetti C, et al. NCCN clinical practice guidelines in oncology: palliative care. J Natl Compr Canc Netw. 2009;7:436–73.
  4. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 14(8):733–42.
  5. Van Beek K, Siouta N, Preston N, Hasselaar J, Hughes S, Payne S et al. To what degree is palliative care integrated in guidelines and pathways for adult cancer patients in Europe: a systematic literature review. BMC Palliative Care 2016;15(1):1-17.
  6. Cardoso F, Costa A, Norton L, Senkus E, Aapro M, Andre F, et al. ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2) dagger. Ann Oncol. 2014;25:1871–88.