Live Longer or Better? Cancer Patients Shouldn't Have to Choose

Betty R. Ferrell, PhD, RN


July 12, 2018

Palliative Care and End-of-Life Care: Not the Same

An enduring misconception about palliative care is that it is reserved for patients at the end of life. This misunderstanding continues to cause delays in the initiation of palliative care for an overlooked population with significant quality of life and symptom concerns—those enrolled in cancer clinical trials.

A recent qualitative study[1] contributes to understanding this barrier to care by interviewing professionals from multiple disciplines involved in the care of clinical trials patients. This study provides insight on the factors influencing the underutilization of palliative care for this patient population as well as possible solutions for improved care.

The investigators conducted qualitative semistructured interviews with 19 key clinicians involved in cancer clinical trials or palliative care; they included principal investigators, oncology fellows, research nurses, inpatient and outpatient nurses, spiritual care providers, and palliative care fellows. Participants were asked about the meaning of the term "palliative care," as well as their experiences with the delivery of palliative care in the clinical trial context. The interviews elicited four major themes:

  • The holistic nature of palliative care;

  • The importance of symptom care;

  • The conflict between palliative care and curative care; and

  • The conflation of palliative care and end-of-life care.

Three more key themes emerged about the delivery of palliative care: (1) dynamics among providers; (2) discussing palliative care with patients and families; and (3) the timing of palliative care delivery.


A sharp contrast divides the clinical needs of cancer patients participating in clinical trials and the care systems that have been designated to support them.[2,3,4] Patients enrolled in these trials, which are important to advance knowledge about treatment, typically have exhausted traditional therapies, have advanced disease, and are already experiencing significant symptoms. Yet, the continued focus of both patients and clinicians on disease-modifying treatment results in an avoidance of palliative care, despite the ever-growing evidence of its benefits.[5,6]

The work of Mollica and colleagues[1] improves our understanding of this dichotomy. The interviews with clinicians highlight the unfortunate association between palliative care and end-of-life care, and the failure to initiate palliative care earlier to optimize care. The study findings advocate improved care delivery models in which palliative care becomes routinely integrated in cancer clinical trials.

This study adds to a growing voice articulating for the reform of cancer care systems, so that patients are not forced to choose between quality of life and extension of life. The American Society of Clinical Oncology[7] and other cancer organizations have made great strides in advancing palliative care. Cancer clinical trial participants should not be excluded from this progress.


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