Palliative care with cancer: what it treats, when to start and what the research shows

A cancer diagnosis brings a treatment plan, and with it a long list of things nobody plans for: pain, nausea, exhaustion, fear, the drive to every appointment. Palliative care is the part of cancer care built for that list. It’s meant to improve the quality of life of people with a serious illness, and it can be given at any point, from diagnosis on, while cancer treatment continues.¹ This note covers what it treats, what the research found, when to ask, and how it’s paid for.

The short answer

• Palliative care can be given at any point during cancer care, from diagnosis to the end of life, and cancer treatment can continue.¹
• It treats pain, fatigue, nausea, poor appetite, shortness of breath and trouble sleeping, and it helps with depression, anxiety and fear.¹
• In a landmark study of advanced lung cancer, people who had palliative care from the start had better quality of life and less depression, and they lived longer.²
• The American Society of Clinical Oncology recommends palliative care for all patients with advanced cancer, and its 2024 update calls for referral early in treatment.^1,3
• Private insurance usually covers palliative care, and Medicare Part B pays for some of its services.¹

What palliative care treats

Palliative care looks at the whole person. It aims to prevent or treat symptoms and side effects early, along with the emotional, social and spiritual weight of the illness.¹ The National Cancer Institute lists the kinds of problems it takes on:¹

• Physical symptoms, such as pain, fatigue, loss of appetite, nausea, vomiting, shortness of breath and trouble sleeping
• Emotional and coping concerns, such as depression, anxiety and fear
• Spiritual questions, with someone who can help a person explore their beliefs and values
• Practical matters, such as money, legal and insurance questions, work, goals of care and advance directives
• The family, because the people giving care can be overwhelmed, and their own health can suffer

Alongside treatment, not instead of it

The most common worry about palliative care is that it means giving up on treatment. It doesn’t. When a person receives palliative care, they may continue to receive cancer treatment.¹ The palliative care team works in close partnership with the person’s other doctors,⁴ and its specialists coordinate with the oncology team.¹

Palliative care specialists have special training or certification in palliative care, and they usually work on a team that can include doctors, nurses, dietitians, pharmacists, physical and occupational therapists, chaplains, psychologists and social workers.¹ Care can be given in a hospital, a clinic, a long-term care facility or at home.¹

What the research shows

In 2010, a study in the New England Journal of Medicine randomly assigned 151 people with newly diagnosed metastatic lung cancer to palliative care from the start, together with their usual cancer care, or to usual cancer care alone.²

• At 12 weeks, the palliative care group had better quality of life.
• Fewer had symptoms of depression: 16%, compared with 38%.
• Fewer received aggressive care at the end of life: 33%, compared with 54%.
• And they lived longer: a median of 11.6 months, compared with 8.9.

The National Cancer Institute sums up the research: bringing palliative care into the care of advanced cancer early can improve quality of life and mood, and may even prolong survival.¹

When to ask

Early. The American Society of Clinical Oncology’s 2024 guideline update reinforces its advice that people with cancer be referred to palliative care early in treatment. It cites new studies showing benefit for people with blood cancers, and it urges cancer doctors to attend to the quality of life of people in early-phase clinical trials too.³

Good moments to bring it up:

• Right after a diagnosis of advanced cancer, or when the cancer has spread or come back
• When pain, nausea or exhaustion keeps getting in the way of daily life
• When side effects make it hard to keep going with treatment
• After a trip to the emergency room or a stay in the hospital
• Before a big decision about the next treatment
• When the person caring at home is running on empty

How to ask

Start with the oncologist or anyone on the oncology team, who can refer you to a palliative care specialist.¹ If the person would prefer to be seen at home, ask about palliative care that comes to the house. Palliative care at home explains what that looks like, and What happens at a palliative care visit explains how to get ready for the first one.

Who pays

Private health insurance usually covers palliative care services, Medicare Part B pays for some services that manage symptoms, and Medicaid coverage of palliative care varies by state.¹ Anyone unsure about coverage can ask a social worker or the hospital’s financial counselor.¹ Who pays for palliative care walks through Medicare, Medicare Advantage and the VA, and Medi-Cal palliative care covers California’s own benefit.

When treatment stops helping

Hospice begins when treatment to cure is no longer the goal and the focus is quality of life.¹ Palliative care can help with that turn, preparing the person for the physical changes, helping them cope and supporting the family.¹ With Medicare, care from a Medicare-approved hospice costs the family nothing, apart from a copayment of up to $5 per prescription for pain and symptom medicines.⁵ Palliative care vs. hospice explains how to tell which one fits.

Questions to ask the oncologist

• Is there a palliative care team where you treat patients, or one that comes to the home?
• Can we start palliative care now, alongside treatment?
• Which side effects should we call you about, and which should we call the palliative care team about?
• Who answers at night and on weekends?
• What are the goals of this treatment, and how will we know if it’s working?