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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.

The Institute of Medicine's National Cancer Policy Forum recently convened a workshop on patient-centered cancer treatment planning, with the aim of raising awareness about this important but often overlooked aspect of cancer treatment. A primary goal of patient-centered treatment planning is to engage patients and their families in meaningful, thorough interactions with their health care providers to develop an accurate, well-conceived treatment plan, using all available medical information appropriately while also considering the medical, social, and cultural needs and desires of the patient and family. A cancer treatment plan can be shared among the patient, family, and care team in order to facilitate care coordination and provide a roadmap to help patients navigate the path of cancer treatment. There are numerous obstacles to achieving patient-centered cancer treatment planning in practice. Some of these challenges stem from the patient and include patients' lack of assertiveness, health literacy, and numeracy, and their emotional state and concurrent illnesses. Others are a result of physician limitations, such as a lack of time to explain complex information and a lack of tools to facilitate treatment planning, as well as insensitivity to patients' informational, cultural, and emotional needs. Potential solutions to address these obstacles include better training of health care providers and patients in optimal communication and shared decision making, and greater use of support services and tools such as patient navigation and electronic health records. Other options include greater use of quality metrics and reimbursement for the time it takes to develop, discuss, and document a treatment plan.

Awareness has grown over the past few years that needs specific to cancer survivors have long been neglected. Clinicians and policy makers continue to struggle, however, with exactly how to address these needs. We present a comprehensive framework for survivorship research and couple it with a model for translating research into policy, using two examples for illustration. Cancer Epidemiol Biomarkers Prev; 20(10); 2099–104. ©2011 AACR.

The Cancer Quality Alliance (CQA), a national alliance advocating for improvements in the quality of cancer care in America, presents a set of 5 case studies that depict a vision of quality cancer care and a "Blueprint" for actions to realize this vision. The CQA Blueprint case studies feature patients with soft tissue sarcoma, breast cancer, rectal cancer, and Hodgkin disease and focus on key phases in the cancer care trajectory: detection, diagnosis, treatment, post-treatment/survivorship, and end of life. Each case study begins with a patient summary, follows with a worst- and a best-case scenario, and concludes with a discussion section identifying "what went right" in the best case and "what went wrong" in the worst case. Steps to be taken by key stakeholders, for example, health care providers, insurers/payers, policy makers, and patients and families, are then outlined. By juxtaposing a worst- and best-case scenario, the cancer care case studies elucidate the origins of complex health care problems and clarify the actions needed to overcome them. The CQA will make the case studies available for use as teaching tools to give health care providers and patients themselves descriptions of how the health care system should work to achieve the ultimate benefit for an individual living with, through, and beyond a diagnosis of cancer. The CQA adopted the definition of quality health care of the Institute of Medicine, and the analysis of care provided in the discussion section of each case study is framed using 6 quality improvement aims identified in the Institute of Medicine's report, Crossing the Quality Chasm: A New Health System for the 21st Century. Health care quality may be judged according to its safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.

Purpose An American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) offers timely clinical direction to ASCO's membership following publication or presentation of potentially practice-changing data from major studies. This PCO addresses the integration of palliative care services into standard oncology practice at the time a person is diagnosed with metastatic or advanced cancer. Clinical Context Palliative care is frequently misconstrued as synonymous with end-of-life care. Palliative care is focused on the relief of suffering, in all of its dimensions, throughout the course of a patient's illness. Although the use of hospice and other palliative care services at the end of life has increased, many patients are enrolled in hospice less than 3 weeks before their death, which limits the benefit they may gain from these services. By potentially improving quality of life (QOL), cost of care, and even survival in patients with metastatic cancer, palliative care has increasing relevance for the care of patients with cancer. Until recently, data from randomized controlled trials (RCTs) demonstrating the benefits of palliative care in patients with metastatic cancer who are also receiving standard oncology care have not been available. Recent Data Seven published RCTs form the basis of this PCO. Provisional Clinical Opinion Based on strong evidence from a phase III RCT, patients with metastatic non–small-cell lung cancer should be offered concurrent palliative care and standard oncologic care at initial diagnosis. While a survival benefit from early involvement of palliative care has not yet been demonstrated in other oncology settings, substantial evidence demonstrates that palliative care—when combined with standard cancer care or as the main focus of care—leads to better patient and caregiver outcomes. These include improvement in symptoms, QOL, and patient satisfaction, with reduced caregiver burden. Earlier involvement of palliative care also leads to more appropriate referral to and use of hospice, and reduced use of futile intensive care. While evidence clarifying optimal delivery of palliative care to improve patient outcomes is evolving, no trials to date have demonstrated harm to patients and caregivers, or excessive costs, from early involvement of palliative care. Therefore, it is the Panel's expert consensus that combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden. Strategies to optimize concurrent palliative care and standard oncology care, with evaluation of its impact on important patient and caregiver outcomes (eg, QOL, survival, health care services utilization, and costs) and on society, should be an area of intense research. NOTE. ASCO's provisional clinical opinions (PCOs) reflect expert consensus based on clinical evidence and literature available at the time they are written and are intended to assist physicians in clinical decision making and identify questions and settings for further research. Because of the rapid flow of scientific information in oncology, new evidence may have emerged since the time a PCO was submitted for publication. PCOs are not continually updated and may not reflect the most recent evidence. PCOs cannot account for individual variation among patients and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient. Accordingly, adherence to any PCO is voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances. ASCO PCOs describe the use of procedures and therapies in clinical trials and cannot be assumed to apply to the use of these interventions in the context of clinical practice. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO's PCOs, or for any errors or omissions.

This session focused on issues related to implementation of randomized clinical trials in palliative care studies. Topics discussed included what kind of clinical sites and patient populations were suitable, what types of clinical investigators (clinical specialty) should be involved in or lead the studies, what multi-site mechanisms could be employed to conduct the trials, and what funding issues were related to these studies. A trial of operative versus nonoperative management for small bowel obstruction caused by recurrent intra-abdominal cancer was considered. The feasibility of such a trial was examined in terms of whether there was “equipoise” for a majority of likely investigators in the field around the trial question, what other issues might impact accrual to the trial, and how many patients would be required to answer which of these two treatment arms was better. This last question is related to selection of a primary endpoint for the trial and was a modestly contentious issue for the trial design group. Both sensible compromises in endpoint selection and the education of the community of investigators for a particular randomized trial in palliative care are crucial steps for successful implementation. A major conclusion of this session is that implementation considerations are intimately related to the architecture of a specific trial and should be addressed practically and early in the design phase of any randomized trial addressing a palliative care question. In this respect, randomized trials in palliative care are no different than in other fields.

Objectives To review the development of advocacy and its influence on health policy from the perspective of AIDS, the American Cancer Society, the Cancer Leadership Council, and the Patient Advocacy Foundation. Data Sources Published articles, news articles, books and personal experience. Conclusions Advocacy on behalf of patients in the health care arena is a powerful force in modern life. Advocacy organizations have been influential in the development of health policy. Implications for Nursing Practice There are a variety of advocacy organizations in which nurses can commit their energies in the support of advocacy.

This special section of Journal of Oncology Practice presents major papers from the first ASCO Quality Symposium. The 2-day symposium was held November 30 and December 1, 2012, in San Diego, CA, and attracted over 660 attendees. In the pages of this issue are selected summations of the presentations from the invited speakers as well as distillations by the session chairs of the 15 abstracts selected for oral presentation. The 280 abstracts selected for poster presentations are available on the ASCO University Web site (http://meetinglibrary.asco.org/abstracts). The organizing committee selected abstracts for oral presentation on the basis of their perception of broad interest. Offerings included translational cancer health services research using large databases and population samples, as well as practical interventions that have improved quality in both large cancer care systems and small oncology practices. All of the selections were intended to promote the quality of cancer care for our patients and our colleagues, and were expected to stimulate additional quality improvement projects; research projects; and, above all, improve patient care. The idea for this meeting began during the year starting in June 2009, during which one of us (D.W.B.) served as ASCO President and another (C.C.E.) was Chair of ASCO's Quality Committee. The theme for that year was “Enhancing Quality through Innovation.”1 Three projects emerged from that year which were designed to improve the provision of quality care to patients with cancer. The first was recognizing and improving quality in real-life practice through the launch of the Quality Oncology Practice Initiative Certification Program. The second project, a rapid learning system to systematize our learning from every patient we treat, has now become the ambitious project CancerLinq.2 In the third project, ASCO's Board of Directors charged the organizers with developing “a scientific assembly that fosters high quality research interactions and discussion among all investigators involved in quality and outcomes science research as recognized complement to the ASCO Annual Meeting.” The result was this Quality Symposium, which aimed to bring together health services researchers (the basic scientists of quality improvement), quality improvement professionals (the translational researchers of quality improvement), and the practitioners of quality improvement. Early on, we recognized that inclusion of the informed patient is critical to any successful quality improvement effort. We sought and obtained the collaboration of the National Coalition for Cancer Survivorship, a broad-based organization founded in 1986 that advocates for quality cancer care for all people touched by cancer. The Coalition3 is a long-time partner with ASCO's quality improvement efforts and readily agreed to help. Together, we hoped that this meeting would be another of their tools to empower people to advocate for themselves. We also sought and received grant support from the Administration for Healthcare Research and Quality. Neither the symposium nor this special section would be possible without the hard work of our colleagues on the organizing committee, to whom we extend our heartfelt thanks. We all hope that the contents of this special section will influence the way oncology will be practiced in 5 years, as well as how the next patient for whom you and your clinical colleagues care will be treated.

Hype or hope? We have heard these words characterize recent reports on this country's so-called "war against cancer." For the eight million people like me who have had cancer, and for the millions that are being diagnosed this year, nothing happens soon enough. But, I am concerned about the message this type of reporting sends to people and the phones that then ring off the hook at my office from people who are desperately looking for a "cure for cancer." How are we going to translate this science into applications for people? How are people going to get access to it? We don't have a healthcare system that wants to pay for clinical research, which is what we're talking about here. This is a serious problem. And this problem is not new to us. My name is Ellen Stovall and I am one of this country's more than eight million cancer survivors. On December 23, 1971, President Richard Nixon signed into law the National Cancer Act. That day also marked something very personal for me. That was the day I began treatment for Hodgkin's disease. I remember going home that night rocking to sleep my two-month-old baby boy, Jonathan. He's now 26. And I remember my dear father calling me to tell me that he had seen the President on television that night, and that the President had declared a war on cancer for me. Today, that seven-year promise goes unfulfilled. Nearly 27 years later, we are still waiting. We have grown tired of waiting. We have been silent too long. We must begin to say, "NO MORE." On September 26, 1998, cancer survivors, their families, friends, caregivers, and co-workers-everyone whose life has been touched by cancer-will rally on The Mall in Washington, D.C. and in communities across the country as part of a national grassroots campaign to make cancer our nation's #1 research and healthcare priority. I invite you to join us in this campaign, called THE MARCH.Coming Together To Conquer Cancertrade mark.