title: Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update.
abstract: Purpose To provide evidence-based recommendations to oncology clinicians, patients, family and friend caregivers, and palliative care specialists to update the 2012 American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) on the integration of palliative care into standard oncology care for all patients diagnosed with cancer. Methods ASCO convened an Expert Panel of members of the ASCO Ad Hoc Palliative Care Expert Panel to develop an update. The 2012 PCO was based on a review of a randomized controlled trial (RCT) by the National Cancer Institute Physicians Data Query and additional trials. The panel conducted an updated systematic review seeking randomized clinical trials, systematic reviews, and meta-analyses, as well as secondary analyses of RCTs in the 2012 PCO, published from March 2010 to January 2016. Results The guideline update reflects changes in evidence since the previous guideline. Nine RCTs, one quasiexperimental trial, and five secondary analyses from RCTs in the 2012 PCO on providing palliative care services to patients with cancer and/or their caregivers, including family caregivers, were found to inform the update. Recommendations Inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment. Referral of patients to interdisciplinary palliative care teams is optimal, and services may complement existing programs. Providers may refer family and friend caregivers of patients with early or advanced cancer to palliative care services.
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Betty R
authors.initials: BR
authors.lastname: Ferrell
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Temin
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Alesi
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Balboni
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Basch
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Janice I
authors.initials: JI
authors.lastname: Firn
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Paice
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Peppercorn
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Tanyanika
authors.initials: T
authors.lastname: Phillips
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Stovall
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
authors.affiliation: Betty R. Ferrell, City of Hope Medical Center, Duarte, CA; Jennifer S. Temel and Jeffrey M. Peppercorn, Massachusetts General Hospital; Tracy A. Balboni, Dana-Farber Cancer Institute, Boston, MA; Sarah Temin, American Society of Clinical Oncology, Alexandria; Erin R. Alesi, Virginia Commonwealth University Health System, Richmond, VA; Ethan M. Basch, University of North Carolina at Chapel Hill, Chapel Hill, NC; Janice I. Firn, University of Michigan Health System, Ann Arbor, MI; Judith A. Paice, Northwestern University, Evanston, IL; Tanyanika Phillips, CHRISTUS St Frances Cabrini Hospital, Alexandria, LA; Ellen L. Stovall, National Coalition for Cancer Survivorship, Silver Spring; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and Camilla Zimmermann, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
mesh_terms: D003142:Communication; D019317:Evidence-Based Medicine; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000191:economics / Q000379:methods / Q000592:standards*; D010348:Patient Care Team; D012017:Referral and Consultation