**4. Time of palliative care in colorectal cancer**

When a cure is no longer possible, treatment is directed toward providing symptomatic relief. The data available today leave little doubt that surgical resection, when feasible, may provide good palliation for some patients with metastatic disease. Although palliative surgery has been the mainstay of palliative care, an individualized multidisciplinary approach, which may involve both surgical and nonsurgical modalities, is probably the best current option [31].

In the last decade major changes in health-care delivery, changing demographics, and new treatment options have significantly changed the cancer patients' trajectory [37]. Now is the time to adapt the current models of palliative care to achieve the strongest dissemination to all cancer care settings. Implementation of palliative care can be achieved through recognition of emerging best practices and financial support to afford this model of care [38].

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

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 colorectal cancer [41].
