Respective limits of palliative care and oncology in the supportive care of cancer patients.

Advanced cancer patients develop a number of devastating physical and psychosocial symptoms before death. In recent years, there have been great advances in our knowledge on the appropriate assessment and management of many of the physical and psychosocial symptoms. There is also increasing understanding on the need for patients and families to receive appropriate follow-up and to have access to multiple settings for optimal care. Unfortunately, both models developed on the basis of palliative care/hospice and those developed on the basis of supportive care/oncology have failed to achieve these goals. Future models for the delivery of supportive cancer care will have to consider the need to ensure that patients receive a consistent level of assessment and management up to the time of death, that there is appropriate flexibility, to allow patients to access multiple levels of care in the trajectory of their illness, and that there is a significant contribution to the body of knowledge and future education of health care professionals. These programs will need to develop individually for each country with due consideration for the structure of the health care system, the structure of the academic system, and the financing of health care in different regions of the world.