Cancer numbers are growing. Projections based on the GLOBOCAN 2012 estimates predict a substantive increase to 19.3 million new cancer cases per year by 2025. Further, people are living longer with cancer; treatments are extending later into the course of the disease. People with cancer have multiple symptoms and problems which become more severe during chemotherapy and in advanced disease. In addition, cancer has emotional and social consequences, affecting the person and their family.

Palliative care seeks to address these issues. Building on the early work of Cicely Saunders, The World Health Organisations definition of palliative care (i.e., the assessment and control of physical, psychological, social, and spiritual problems in patients and their families from diagnosis, until the end of life, and into bereavement) is broadly accepted worldwide.

Palliative care needs to become part of the global health agenda with a public health approach to its development, considering the epidemiology of need and the effectiveness of alternatives. A systems approach can help to plan how palliative care is developed in different context. This uses the CATWOE approach that appraises: Customers (patients and families, their needs), Actors (available workforce, doctors, nurses etc), Transformation (current structure, process, outcomes of care), World view (culture, attitudes), Owners (voluntary, national health service, founders), and Environment (rural, urban, transport). This approach ensures strategy is based on evidence of local preferences, priorities and circumstances. The timing and level of integration of palliative care is also important. There is research showing potential benefits when palliative care is involved from the point of diagnosis in incurable cancer.

This presentation will consider the levels of evidence for the different models, and suggest a possible way forward.