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September 19, 2019

Prolonged Survival With Palliative Care—It Is Possible, but Is It Necessary?

Author Affiliations
  • 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
JAMA Oncol. 2019;5(12):1693-1694. doi:10.1001/jamaoncol.2019.3100

Palliative care is defined as care provided by a specially trained team of clinicians that is both patient and family centered and seeks to enhance quality of life throughout the continuum of illness.1,2 Multiple studies have reported benefits associated with integrating early palliative care with standard oncology care for patients with advanced cancer to address patients’ symptoms, understanding of their disease, coping strategies, and medical decision-making.3-7 Consequently, guidelines recommend early integration of palliative care for patients with advanced cancer, concurrently with disease-directed and life-prolonging treatment.1,2 Despite the established benefits and guideline recommendations for early integration of palliative care in oncology, many patients do not receive palliative care services or receive them late in the illness trajectory, potentially due to both patient and clinician misperceptions that palliative care is appropriate only after a patient has discontinued life-prolonging therapies.8 Thus, a growing body of literature has sought to demonstrate that palliative care improves patient outcomes without shortening survival.

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2 Comments for this article
Palliative Care
Edward Volpintesta, MD | 155 Greenwood Avenue Bethel CT
Even if it does not prolong survival and even if it is not necessary, palliative care epitomizes our roles as healers. 

How can anything so closely connected to our roles as healers of physical and mental suffering ever be considered not necessary?

Donna Carlson, MD MPH JD | Loma Linda University School of Medicine
Palliative care of those afflicted with incurable diseases, as Dr. Volpintesa writes, is always necessary. It was perhaps best described 500 years ago by Thomas More in his most famous essay. The Utopians, More suggested, "look after their sick, so that nothing is left undone which may contribute either to their health or ease. And as for those who are afflicted with incurable disorders, they use all possible means of cherishing them and of making their lives as comfortable as possible; they visit them often, and take great pains to make their time pass easily."