American Society of Clinical Oncology guideline update on palliative care for patients with cancer: Addressing the reality gap

Plain Language Summary We commend the American Society of Clinical Oncology for their sweeping recommendations and advocacy for integrated palliative care as part of oncologic care. The literature that exists is heterogeneous and at times difficult to interpret, and the panel has clearly described their systemic review process and subsequent rationale for their recommendations. Although we agree with the overall recommendations, there are significant practical limitations to their application that renders them aspirational. We worry that the guidelines may be impossible for most programs to fully achieve due to a variety of factors including specialty palliative care workforce shortages, limited health care system resource allocation to integrate palliative care widely in cancer care, and lack of financial support for the research necessary to better answer outstanding clinical and implementation questions. We outline briefly some practical ways in which these recommendations can be applied by existing cancer centers and health care systems. Ultimately, both financial and quality incentives will be necessary to push forward the expansion and integration of palliative care within our national health care system as a whole.