**6. Conclusion**

Colorectal carcinoma is a frequent entity, with many patients being diagnosed with metastatic disease "de novo" or having recurrences of the disease after primary treatment.

Although a fraction of patients may undergo resection of metastases with curative intent, the vast majority will remain eligible only for palliative treatment modalities, which may include surgery or systemic antineoplastic therapy.

**211**

**Author details**

Ricardo Caponero

Centro de Oncologia do Hospital Alemão Oswaldo Cruz, São Paulo, Brazil

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

\*Address all correspondence to: r.caponero@gmail.com

provided the original work is properly cited.

*Palliative Care in Colorectal Cancer*

their families.

are needed.

into community practice.

oncology clinicians.

*DOI: http://dx.doi.org/10.5772/intechopen.93513*

Fundamentally, the practice of palliative care includes an impeccable control of symptoms, good communication, and psycho-emotional support for patients and

The demand for palliative care to be integrated throughout the cancer trajectory, combined with a limited palliative care workforce, means that new models of care

Palliative care began in academic centers with specialty consultation services,

Volunteering can help fill most of the gaps in palliative care, but its implementa-

This chapter discusses evidence regarding the need for integration of palliative care into routine oncology care and describes the best practices recognized for dissemination of palliative care. The available evidence suggests that palliative care be widely adopted by clinicians in all oncology settings to benefit the patients with cancer and their families. Efforts are needed to adapt and integrate palliative care

The benefits of palliative care can only be realized through effective dissemina-

tion of these principles of care, with more primary palliative care delivered by

and its value to patients, families, and health systems has been evident.

tion is still difficult and restricted to some more developed centers.

### *Palliative Care in Colorectal Cancer DOI: http://dx.doi.org/10.5772/intechopen.93513*

*Colorectal Cancer*

colorectal cancer [41].

**5. Expected results**

burden [43].

The difference between curative and palliative care lies in defining the main goal of treatment, since palliative treatments can extend life [39]. Palliative care is incorrectly associated with the suspension of all forms of antineoplastic therapy, but the persistence of inappropriate antitumor treatments in non-responding patients and

A report from a retrospective cohort study including all patients who died of colorectal cancer between 2004 and 2012 in Manitoba, Canada, provides the better evidence that early palliative care involvement is associated with decreased odds of dying in hospital and lower health-care utilization and costs in patients with

The goal of palliative care is improvement of quality of life. Good communication skills and flawless symptom control is associated with improved patient and family quality of life, greater treatment compliance, and may even offer survival advantages [42]. A 2016 meta-analysis evaluated 40 palliative care trials and concluded that this care was associated with improved patient quality of life and control of symptom

The American Society of Clinical Oncology (ASCO) recommends the integration of palliative care into oncology practice [23], but despite the increasing evidence of the benefits of palliative care there is little consensus regarding strategies for integrating palliative care into the routine practice of oncology [44]. The lack of qualified professionals, the difficulties of access and the remuneration of professionals are still the biggest obstacles, especially in underdeveloped countries. Palliative care has emphasized support for family caregivers. Although the family caregiver literature is even more limited than patient-focused studies, there is growing evidence of the benefits of palliative for family caregivers [15], but our current models of remuneration are insufficient to cover the care of the patient's

For palliative care to be truly integrated into oncology care, it will need to take on new forms, expanding for greater use in outpatient and community settings, survivorship clinics, and the most important, primary practice of oncology [45]. In an era of limited resources and incremental costs of health care, expanding palliative care capacity to meet clinical guidelines and population health needs seems to save costs. The major problem is a significant variance in estimates of the effects of treatment on costs, depending on the timing of intervention, the primary

Because ASCO guidelines state that palliative care should be provided concurrently with other treatment from the point of diagnosis onward for all metastatic cancer, a broad evaluation is required to evaluate the cost effects of palliative care

Colorectal carcinoma is a frequent entity, with many patients being diagnosed with metastatic disease "de novo" or having recurrences of the disease after primary

Although a fraction of patients may undergo resection of metastases with curative intent, the vast majority will remain eligible only for palliative treatment

modalities, which may include surgery or systemic antineoplastic therapy.

overly aggressive care often affects a patient's quality of life [40].

family members, and especially in the assistance to bereavement.

diagnosis, and the overall illness burden.

across the entire disease trajectory [46].

**210**

**6. Conclusion**

treatment.

Fundamentally, the practice of palliative care includes an impeccable control of symptoms, good communication, and psycho-emotional support for patients and their families.

The demand for palliative care to be integrated throughout the cancer trajectory, combined with a limited palliative care workforce, means that new models of care are needed.

Palliative care began in academic centers with specialty consultation services, and its value to patients, families, and health systems has been evident.

Volunteering can help fill most of the gaps in palliative care, but its implementation is still difficult and restricted to some more developed centers.

This chapter discusses evidence regarding the need for integration of palliative care into routine oncology care and describes the best practices recognized for dissemination of palliative care. The available evidence suggests that palliative care be widely adopted by clinicians in all oncology settings to benefit the patients with cancer and their families. Efforts are needed to adapt and integrate palliative care into community practice.

The benefits of palliative care can only be realized through effective dissemination of these principles of care, with more primary palliative care delivered by oncology clinicians.
