Research has found that patients with advanced disease and/or high symptom burden benefit from receiving integrated palliative care early in the cancer disease process. Palliative care, delivered either jointly with standard cancer care, or as the sole focus of care, is associated with decreased symptom burden; improved quality-of-life, mood, survival, patient/caregiver satisfaction and understanding of disease prognosis over time; and decreased utilization of aggressive end-of-life care. Earlier palliative care referrals result in fewer presentations to A&E, admission to hospital and hospital deaths.
Comparable to patients receiving treatment with other cancer treatment modalities (e.g., chemotherapy, radiation therapy) patients receiving immunotherapy and their families should undergo screening and be offered and/or provided with integrated palliative care services throughout the cancer care continuum to minimize cancer-related symptoms and improve quality-of-life. However, this is challenging as patients receiving immune therapy differ from palliative care needs in patients taking other systemic treatments as a result of differing mechanisms of action and side-effect profiles.
Even more challenging is the fact that while immunotherapy may be better tolerated compared with traditional systemic therapy, a significant number of patients experience treatment-related side effects (e.g., rash, cough, arthralgia, fatigue). In addition, compared with chemotherapy, the timing and type of clinical response to immune checkpoint therapy may be variable. This may make it challenging to differentiate who is responding. Further, there are no reliable markers of treatment response.