**5. Expected results**

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 burden [43].

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 family members, and especially in the assistance to bereavement.

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 diagnosis, and the overall illness burden.

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 across the entire disease trajectory [46].
