**1. Introduction**

Cancer considers the first cause of death globally and it is accounting for about 10 million deaths in 2020 [1]. It has bad impact on physical and social life. Patients with cancer may experience one symptom or more at one time. Those with advanced disease that characterized by breathlessness and metastatic cancer may have on average about 14 symptoms [2], including symptoms of cancer itself and the side effect of cancer therapies [3].

Non-curative therapy creates a multidisciplinary effort for patients whose disease is unresponsive to indicated treatment curative intent, so its purpose is life-enhancing and prolonging. Those patients will go through progressive disease, that makes patients suffer from restlessness as a result of their illness, strategies of treatment, which negatively affect their treatment and the recovering handle, so, it is fundamental to control and reduce such suffering, which makes them need a shift in the objective of medical care. Despite the fact, that life-prolonging treatment can provide prolonged disease control with the present armamentarium of treatment modalities, side effects such as pain, anxiety, depression, fatigue, dyspnea, diarrhea, loss of appetite, nausea, and vomiting, often reduce the patient's quality of life [4–8].

In order to prevent/palliate these negative impacts of the outcomes of the disease and to enhance quality of life of patients and their families, the urgency for palliative care as the main goal in providing therapy and care for patients who face problems of life-threatening diseases. Palliative care can relieve of the patient's suffering by early identification, evaluation and treatment of physical, psychological, and social problems that include request for hastened death, assistance with making decision or care planning, patient demand for referral, spinal cord compression, delirium, brain, or leptomeningeal metastases [9–13].

According to the World Health Organization (WHO), more than 50% of the countries in the world are making efforts to provide treatment and palliative care for cancer patients. At the same time, many countries do not have a cancer control program [14]. Approximated cancer patients require more than one-quarter of global palliative care need [15]. Lack of enough communication enhance stress, decrease patient satisfaction, and decrease strictly following medical instructions, so adequate collection of data at a palliative care service enhance quality of patient care [16–18]. Early appearance of palliative care enhances quality of life, decreases therapeutic cost, and superior survival time. But, to provide convenient care to cancer patients, it is necessary to refer them to health services timely [19].

The core focus of palliative care also improves the care quality for the health care system [20, 21]. Besides improving physical symptoms, it will reduce emergency visits and reduces hospital admissions. For patients who have not taken palliative care at all or who came late to palliative care are more probably to receive invasive treatments, such as chemotherapy, and increase risk of death from treatment complications. Starting the palliative care at the time of diagnosis provides an adjuvant partnership for the treatment team and as the disease develops, the need for palliative care increases. That's why it is suggested that palliative care be started in the first 8 weeks after the onset of the disease and the American Society of Oncology Guidelines also suggested that palliative care be initiated at the onset of cancer for some patients [22–25].

That's can improve all phases of the disease, it makes better decisions in the endof-life care and potentially decreases health-care expenditures [26], and can generate consequential savings for the health system by decreasing hospitalization and interventions [27].
