**1. Introduction**

As a discipline, palliative care (PC) has developed rapidly since the launch of the pioneering hospice movement by Dame Cicely Saunders in the 1960s. It has become inextricably connected to optimal care for patients with serious illnesses and is now widely considered a key component of oncologic therapy in patients with advanced

tumors. Moreover, it is widely agreed that patients with advanced malignancies should be referred to a PC physician at the earliest possible instance [1]. Many studies have shown that PC can improve the quality of life (QoL) of patients and their families and caregivers [2, 3].

Lung cancer is associated with high mortality and morbidity rates. It is the leading cause of cancer-related deaths in the United States, accounting for 25.9% of all cancer-related deaths in 2017 [4]. Currently, the anticipated 5-year survival rate for patients with lung cancer is only 18.1%. Even for patients with stage 1 non-small cell lung cancer (NSCLC), the 5-year overall survival rate is 73–90%, while for those with stage 4 NSCLC, it is a dismal 0–10% [5]. A meta-analysis including more than 5,000 patients with lung cancer showed that the average survival time of patients who do not undergo antineoplastic treatment is approximately 7 months [6]. Although lung cancer incidence and mortality are now declining, its prevalence remains high, with more than 500,000 people in the United States currently living with the disease [7]. For patients with advanced lung cancer, the burden of the disease, its consequences, and treatment side effects can dramatically reduce the QoL.

Lung cancer can take various forms, ranging from a silent or minimally symptomatic illness with a low burden and/or moderate progression to an aggressive and fastprogressing disease with severe symptoms. Survival rates and QoL tend to be worse in patients with advanced lung cancer experiencing severe symptoms [8]. Lung cancer symptoms include pain, nausea, dyspnea, fatigue, anorexia/cachexia, depression, and confusion/delirium [9]. Because of the high prevalence and symptom burden of the disease, the impact of PC on patients with lung cancer has attracted great research attention in recent years.

This chapter is structured to offer readers a coherent, systematic overview of the current developments and practices in the field of PC for patients with lung cancer. It starts with a brief introduction of the concepts underpinning PC, followed by an overview of research evidence that supports the role of PC in patients with lung cancer. Next, we discuss the criteria for identifying potential candidates for PC referral and explore various PC delivery models. Finally, we examine how holistic care is provided to the patients through different interventions.
