“Palliative” or “Supportive”: Is It Just a Matter of Word?

Dear Editor:

We read with interest the article about the impact of the terms “supportive care,” “palliative care,” and “hospice” on patients. ¹ On the subject, let us recollect what was published by S. Dalal: the changing of the name of his service, from “palliative care” to “supportive care,” had led to an increase of consultancies of 41% and an anticipation of access to supportive care center of about four months. ²

Recently, European Society for Medical Oncology hypothesized that the term “palliative care” could have a negative impact on patients, proposing to replace it with “patient-centered care”. ³

Oncologists, patients, and scientific societies suggest us to change the name of the service from “palliative care” to “supportive care.” As far as we are concerned, we already had the perception that the term “palliative care” could be a negative stigma, so in 2002, we defined our service “Supportive Care Task Force”. ⁴

The question today is whether it is only a question of terminology or whether there is something else. Is it the delay in accessing palliative care centers, just a matter of words? The term “palliative care” refers to a by far outdated vision of oncology, to when cancer was an “acute” disease, and the disease-oriented therapies had almost no impact on patients' medical history. As a result, the patient used to pass within a few weeks from diagnosis to the hospice.

At that time hospice, with a low therapeutic intensity and exclusively devoted to end-of-life care, made sense. In the era of targeted therapies and immune checkpoint inhibitors, when cancer is about to become, and partly already is, a chronic disease, is the discussion still current? Should not we move forward, modernizing the founding principles of “palliative care”? In this future that has already begun, we need supportive care centers capable of integrating with oncology services, even from a structural point of view. The time from diagnosis to end of life will last years, and to meet the needs of this revolution, the name changing is not enough. We will be called to treat symptoms for a long time, to manage new class-specific toxicities and the burden of comorbidities, considering that by living longer, our patients are getting older and older.

Moreover we will be called to pay attention to the quality of this “gain of life,” trying to guarantee an “active” lifestyle during the different lines of treatment. To achieve this, we will need outpatient “supportive” services within oncology departments, able to assess and handle symptoms with a high-intensity care approach. That same services, when it is necessary, will offer to the patients the end-of-life care, without interrupting the continuity of their care, which is established in years of relationship. In our opinion, all that is definitely more “supportive” than “palliative.” It is not just a matter of word, it is something deeper. Even the content must be updated, otherwise, inevitably, it will be overtaken by time. Because, as Bob Dylan said in the 60s, “the times they are a’ changing …”.