Stein Kaasa|Jon Håvard Loge|Matti Aapro|Tit Albreht|Rebecca J. Anderson|Éduardo Bruera|Cinzia Brunelli|Augusto Caraceni|Andrés Cervantes|David C. Currow|Luc Deliëns|Marie Fallon|Xavier Gómez-Batiste|Kjersti Støen Grotmol|Breffni Hannon|Dagny Faksvåg Haugen|Irene J Higginson|Marianne Jensen Hjermstad|David Hui|Karin Jordan|Geana Paula Kurita|Philip Larkin|Guido Miccinesi|Friedemann Nauck|Rade Pribakovic|Gary Rodin|Per Sjøgren|Patrick Stone|Camilla Zimmermann|Tonje Lundeby
Integration of oncology and palliative care: a Lancet Oncology Commission
University of Oslo|Oslo University Hospital|Oslo University Hospital|University of Oslo|Clinique de Genolier|National Institute of Public Health|Marie Curie|University College London|The University of Texas MD Anderson Cancer Center|Fondazione IRCCS Istituto Nazionale dei Tumori|Fondazione IRCCS Istituto Nazionale dei Tumori|Universitat de València|INCLIVA Health Research Institute|University of Technology Sydney|Hull York Medical School|University of Hull|Vrije Universiteit Brussel|Ghent University|Ghent University Hospital|MRC Institute of Genetics and Molecular Medicine|University of Edinburgh|Universitat de Vic - Universitat Central de Catalunya|Institut Català d'Oncologia|Oslo University Hospital|University of Toronto|Princess Margaret Cancer Centre|University Health Network|Haukeland University Hospital|Cicely Saunders International|King's College London|University of Oslo|Oslo University Hospital|The University of Texas MD Anderson Cancer Center|University Hospital Heidelberg|Heidelberg University|Copenhagen University Hospital|Rigshospitalet|University Hospital of Lausanne|University of Lausanne|University of Göttingen|Universitätsmedizin Göttingen|National Institute of Public Health|Princess Margaret Cancer Centre|University Health Network|University of Toronto|Copenhagen University Hospital|Rigshospitalet|University of Copenhagen|Marie Curie|University College London|University of Toronto|Princess Margaret Cancer Centre|University Health Network|University of Oslo|Oslo University Hospital
full integration oncology palliative care relies specific knowledge skills two modes care tumourdirected approach main focus treating disease hostdirected approach focuses patient disease commission addresses combine two paradigms achieve best outcome patient care randomised clinical trials integration oncology palliative care point health gains improved survival symptom control less anxiety depression reduced use futile chemotherapy end life improved family satisfaction quality life improved use healthcare resources early delivery patientdirected care specialist palliative care teams alongside tumourdirected treatment promotes patientcentred care systematic assessment use patientreported outcomes active patient involvement decisions cancer care result better symptom control improved physical mental health better use healthcare resources absence international agreements content standards organisation education research palliative care oncology major barriers successful integration barriers include common misconception palliative care endoflife care stigmatisation death dying insufficient infrastructure funding absence established priorities might also hinder integration widely commission proposes use standardised care pathways multidisciplinary teams promote integration oncology palliative care calls changes system level coordinate activities professionals development implementation new improved education programmes overall goal improving patient care integration raises new research questions contribute improved clinical care palliative care delivered optimal model integrated care biological clinical effect living advanced cancer years diagnosis successful integration must challenge dualistic perspective either tumour host instead focus merged approach places patients perspective centre succeed integration must anchored management policy makers levels health care followed adequate resource allocation willingness prioritise goals needs sustained enthusiasm help generate support better integration integrated model must reflected international national cancer plans followed developments new care models education research programmes adapted specific cultural contexts within situated patientcentred care integrated part oncology care independent patient prognosis treatment intention achieve goal must based changes professional cultures priorities health care