Palliative medicine and medical oncology

Traditionally, medical oncology and palliative care have been considered tw o distinct and separate disciplines, both as regards treatment objectives a nd delivery times. Palliative care in terminal stages, aimed exclusively at evaluating and improving quality of life, followed antitumor therapies, wh ich concentrated solely on quantitative results (cure, prolongation of life , tumoral mass shrinkage). Over the years, more modern concepts have develo ped on the subject. Medical oncology, dealing with the skills and strategic co-ordination of oncologic interventions from primary prevention to termin al phases, should also include assessment and treatment of patients' subjec tive needs. Anticancer therapies should be evaluated in terms of both the q uantitative and qualititative impact on patients' lives. Hence, the traditi onal view of palliative care has to be modified: it constitutes a philosoph ical and methodological approach to be adopted from the early phases of ill ness. It is not the evident cultural necessity of integrating medical oncol ogy with palliative medicine that may be a matter of argument, but rather t he organizational models needed to put this combined care into practice: sh ould continuous care be guaranteed by a single figure, the medical oncologi st, or rather by an interdisciplinary providers' team, including full-time doctors well-equipped for palliative care? In this paper the needs of cance r patients and the part that a complete oncologist should play to deal with such difficult and far-reaching problems are firstly described. Then, as m ild provocation, data and critical considerations on the ever increasing ne eds of palliative care, the present shortcomings in quality of life and pai n assessment and management by medical oncologists, and the uncertain effic acy of interventional programmes to change clinical practice are described. Finally, a model of therapeutic continuity is presented, which in our view is realistic and feasible: an Oncologic Programme as the unifying process, and the Comprehensive Cancer Centre, or the Oncologic Department, the deli vering structure.