Palliative care is clearly defined by WHO 2002 as active total care, which is multidimensional, interdisciplinary, and patient-focused, and is applicable also earlier in the course of disease together with disease-modifying treatments until death and beyond. Typical components of palliative care [Jacobsen J, J Pall Med 2011] include proactive, multidimensional and quantitative symptom-assessment, communication interventions emphasizing both preparation for the dying process and maintaining hope, or coordination of high quality support networks. Typically, these palliative care interventions are delivered by specialized palliative care interdisciplinary teams with formal training [Centeno C, Pall Med 2007] and a frequent clinical exposure to core palliative care themes.
However, in several settings and countries, these teams do not exist or are often involved only close to the death of patients, and have only limited understanding of cancer disease. Palliative care competencies are increasingly adopted as a core quality of (medical) oncology (Core curriculum ESMO/ASCO) and many centers have mandatory rotation to specialist palliative care. However, oncologists delivering palliative care may often limit their interventions to only controlling the toxicity of anticancer treatments and of physical symptoms.
It is therefore vital to gain a better understanding which professions and which competencies are successfully delivering high quality and cost efficient palliative care interventions.

Aim: To describe and disseminate the content, competencies and care processes of specialist palliative care practices in service models of integrated oncology and palliative care at comprehensive cancer centers.

Objectives:

1. To systematically collect current literature describing models, tools and practices of integration of medical disciplines and specialist palliative care.
2. To explore the presence of comprehensive cancer centers having specialist palliative care service by an international survey, answered voluntarily.
3. To collect content, competencies and care processes of specialist palliative care services working in comprehensive cancer centers and characterize the procedures of integration with oncology.
4. To contribute to education about integration of specialist palliative care and oncology.

1. The systematic literature review applyes standard methods (search strategy: identification, screening, eligibility, inclusion; assessment of article applying STROBE criteria and Cochrane for quality). The data base search, selection of papers, and preliminary data extraction by a core team (lead: Saskia Teunissen; involved: E. de Graaf, Augusto Caraceni, Nathan Cherny, Rolf Oberholzer, Florian Strasser) is expected to be finished by 30. September 2011. For the full paper selected additional experts in specialist palliative care are invited, who are interested in the work of the task force, to critically review the findings including contribution in final data extraction. Critiera and options for experts will be proposed by the chairs of the Task Force to the EAPC board in december 2011. The paper shall be submitted for publication by March 2012.

2. An international survey to find the level of palliative care development, program development, education and integration with other subspecialties was developed in 2011 by the palliative care group of the Multinational Association of Supportive Care in Cancer (MASCC), in collaboration with ESMO (Chair Palliative Care Working Group, Nathan Cherny) and EAPC (Chair of this task force, Florian Strasser). The content and approach is oriented on the US survey [Hui D, JAMA 2010] and adapted to cover the European countries too. The survey is expected to be launched in Q4/2011, data will be available by Q1/2 2012, and a manuscript is expected to be submitted by end of Q2/2012. The writing committee will encompass the people involved in preparation, and in addition interested members of this Task Force able to invest in data analysis and manuscript preparation.

3. An online survey requesting content, competencies and care processes of specialist palliative care practices and of the institutionalized integration procedures is developped by the co-chairs of the TF (lead FS), based on own experience and preliminary results of the literature review. A draft version, including inclusion criteria for participants, is expected by 31. october 2010. The participants of the prior meetings on integration of oncology and palliative care, conducted at EAPC meetings, and persons already known to the chairs as being actively interested, as well as the EAPC board, will receive the draft survey for revision, and for voicing interest to participate, by e-mail. The final survey is expected to ready in december 2011. It will be answered only by the specialist palliative care teams. The data analysis and manuscript writing will be lead by the chairs of the TF, amended by interested participants. A manuscript is expected to be submitted by end of Q2/2012.

4. Upon invitation of ESMO, the PCWG, the chair of the TF (Florian Strasser) made an e-learning module on integrationof oncology and palliative care. A link to this e-learning may be provided by EAPC, also an additional commentary of members of the EAPC board may be amended.

Expected results:
1. Examples of best practices models of integration.
2. Improved evidence base and updated research agenda.
3. Argumentarium to further improve effectiveness of specialist palliative care in specific disciplines. To improve integration of appropriate ressources of both patients who do not get access to oncological care when cared for by specialist palliative care and patients in oncology who have unmet palliative care needs.

• ESMO - European Society for Medical Oncology
• MASCC - Multinational Association of Supportive Care in Cancer
• University Medical Center Utrecht, The Netherlands
• Cantonal Hospital St.Gallen, Switzerland

An EU-Application Health 2012 on integration of oncology and palliative care is written by a committee including members of the TF chairmanship / steering committee. In case the consortium’s project gets accepted (Q2/2012), a strong collaboration with the TF is foreseen, new objectives and milestones will be necessary.