“Palliative care is not paid for in our system until you get to hospice,” Dr. Ward said. “We believe that when you bundle payments, you begin providing better palliative care. If I’m an oncologist spending 30% of my time giving palliative care but I’m not really trained and am not an expert in it, then I can develop palliative care in my practice and bring in a palliative physician. Bundling allows me to maximize efficiency.”

ASCO is meeting with officials at the Centers for Medicare & Medicaid Services to discuss the possibility of a pilot project for the proposed payment reforms.10

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Oncologists Should Seek Palliative Care Expertise

While Dr. Ward emphasizes that ASCO’s proposed Medicaid payment reforms for cancer care would allow practices to hire palliative care physicians, others emphasize that oncologists must equip themselves with palliative care expertise, or even prepare to become the primary palliative care providers for their patients with advanced cancer.11,12

“General palliative care is mandatory for any physician who is caring for patients with incurable and advanced disease,” reported Jan Gaertner, MD, of the department of palliative care at University Medical Center Frieburg, in Freiburg, Germany, and colleagues.12

Communication is key to the successful integration of palliative care. Discussions about palliative care should be honest, simple, direct, and empathetic, acknowledging the patient’s physical and emotional suffering.12

While Dr. Gaertner’s team refers patients to a palliative care team, practice guidelines for symptom management are “readily available”, Dr. Gaertner noted, and these should be known and kept on hand by oncologists.

Dr. Gaertner and colleagues cited several examples:

  1. Portenoy RK. Treatment of cancer pain. Lancet. 2011;377(9784):2236-2247.
  2. Levy MH, Adolph MD, Back A, et al. Palliative care. J Natl Compr Canc Netw. 2012;10(10):1284-1309.
  3. Bennett MI, Graham J, Schmidt-Hansen M, et al. Prescribing strong opioids for pain in adult palliative care: summary of NICE guidance. BMJ. 2012;344:e2806.
  4. Caraceni A, Hanks G, Kaasa S, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol. 2012;13(2):e58-e68.


  1. Smith TJ, Temin S, Alesi ER, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol. 2012;30(8):880-887.
  2. Battley JE, Connell LC, O’Reilly S. Early specialty palliative care. N Engl J Med. 2014;370(11):1075.
  3. Nyhan B, Reifler J, Ubel PA. The hazards of correcting myths about health care reform. Med Care. 2013;51(2):127-132.
  4. Irwin KE, Greer JA, Khatib J, et al. Early palliative care and metastatic non-small cell lung cancer: potential mechanisms of prolonged survival. Chron Respir Dis. 2013;10(1):35-47.
  5. Ferris FD, Bruera F, Cherny N, et al. Palliative cancer care a decade later: accomplishments, the need, next steps—from the American Society of Clinical Oncology. J Clin Oncol. 2009;27(18):3052-3058.
  6. Greer JA, Jackson VA, Meier DE, Temel JS. Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA Cancer J Clin. 2013;63(5):349-363.
  7. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742.
  8. Lefkowits C, Binstock AB, Courtney-Brooks M, et al. Predictors of palliative care consultation on an inpatient gynecologic oncology service: are we following ASCO recommendations? Gynecol Oncol. 2014;133(2):319-325.
  9. Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population; Board on Health Care Services; Institute of Medicine; et al. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington (DC): National Academies Press (US); 2013.
  10. Furlow B. New proposals to improve US cancer care and control costs. Lancet Oncol. 2014;15(9):921-922.
  11. Rangachari D, Smith TJ. Integrating palliative care in oncology: the oncologist as a primary palliative care provider. Cancer J. 2013;19(5):373-378.
  12. Gaertner J, Weingärtner V, Wolf J, Voltz R. Early palliative care for patients with advanced cancer: how to make it work. Curr Opin Oncol. 2013;25(4):342-352.