Nature reviews. Clinical oncology
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Despite improvements in cancer therapies, cancer is the leading cause of death worldwide. Many patients experience severe, unnecessary symptoms during treatment as well as at the end of life. Often, patients receive 'aggressive' care at the end of life that is discordant with their preferences. ⋯ The specialty and associated infrastructure is expanding rapidly with support from the international medical community. The ideal model of how to incorporate palliative care providers into the care of patients with cancer is yet to be defined; future research is needed to develop delivery systems and improve access to palliative care services. Through collaboration between oncologists and palliative care teams, there is hope of improving the quality of care for patients with both curable and life-limiting cancers.
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Over the past two decades, paediatric palliative care has emerged as both a primary approach and as its own medical subspecialty, the overall aim of which is to ease suffering for children with life-threatening illness and their families through a concurrent model of care. However, most discussions have been focused on the transition to palliative care when no realistic hope for cure exists. ⋯ This article will examine our current understanding of several areas of palliative care, with the ultimate message that palliative care is simply a novel term for the total care of a child and family, an approach that should be applied consistently and concurrently regardless of disease status. By improving familiarity with palliative care and building relationships with palliative care specialists, the paediatric oncology clinician will ensure that the best care possible for children and families is provided, regardless of outcome.
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Access to pain relief is a crucial concern for patients with cancer, and remains so at all stages of the illness trajectory. This Review covers the scope of the problem and considers the optimal palliative strategy, mainly through the use of opioids. It also discusses various barriers to effective pain management around the world, including regulatory and attitudinal barriers towards opioids, and the unwillingness of national governments to integrate palliative care effectively in cancer control efforts.