Keywords
Gastrointestinal cancer
Oncology
Palliative care
Quality of life
How to Cite
Abstract
Background: Early palliative care is increasingly recognized as an important component of high-quality cancer care; however, the timing and extent of its integration vary across oncologic disciplines, including gastrointestinal (GI) oncology. Patients with GI malignancies frequently experience early symptom burden, complex treatment courses, and prognostic uncertainty, contributing to substantial supportive care needs over the disease trajectory.
Methods: This narrative review synthesizes evidence on early palliative care in gastrointestinal oncology from randomized controlled trials, systematic reviews, GI oncology–specific clinical guidelines, and observational and health services research. The objective was to characterize patterns of evidence, implementation approaches, and ethical considerations relevant to early integration in gastrointestinal oncology.
Results: Across heterogeneous study designs, early palliative care involvement is associated with improvements in quality of life, symptom control, and communication outcomes, without evidence of interference with disease-directed therapies. In GI oncology, particularly pancreatic cancer and hepatocellular carcinoma, unmet supportive care needs are consistently described. Diagnosis-anchored and needs-based referral approaches are discussed as alternatives to time-based models in settings of prognostic uncertainty. Evidence supporting home-based or hybrid palliative care models in GI oncology remains limited and context dependent.
Conclusion: Overall, the literature suggests that earlier integration of palliative care may be appropriate for selected patients with gastrointestinal malignancies. Given variability in symptom burden and clinical trajectories, time-based referral models may be insufficient in some settings, whereas needs-based and diagnosis-anchored approaches may offer flexible frameworks. Ethical considerations should be interpreted in light of patient preferences, feasibility, and health system capacity, rather than framed as universal mandates.
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