European Experts Agree on How Palliative Care Should Serve Patients Living With Advanced Cancer

Modern cancer medicine has produced a paradox that few clinicians anticipated a generation ago: people with locally advanced or metastatic cancer are living longer than ever before, yet many of them continue to endure a heavy burden of physical, psychological, social, and spiritual distress. As survival curves stretch, the question of who should care for these patients during the extended years they now spend with incurable disease has become one of the most pressing unresolved issues in oncology. A new European study published in Supportive Care in Cancer offers the most systematic answer to date, using a rigorous consensus method to define exactly what specialist palliative care services should, and should not, be expected to provide for this growing population.

The study, part of the PRiSM project and led by Amy Taylor and Andrew Davies of Trinity College Dublin and Our Lady’s Hospice & Care Services, together with a large collaborative group of experts, employed an electronic Delphi methodology to distill the views of specialists across the continent. The Delphi technique is a structured process designed to achieve group agreement without the distortions of face-to-face dynamics: participants answer questionnaires independently, receive anonymized feedback on how the whole group responded, and then revise their answers over successive rounds. In this case, the researchers ran three rounds, inviting participants to rank their agreement with statements derived from systematic literature reviews, to suggest modifications, and to review responses relevant to the group’s collective position. Consensus was pre-defined as at least 75 percent agreement, and the researchers used Spearman’s rank order correlation to test whether opinions had stabilized between rounds, along with the chi-square test for goodness of fit to compare group results.

The scale of the expert engagement is one of the study’s most striking features. Eighty-six specialists in palliative care and 54 oncology experts from across Europe took part, drawn from international and national organizations as well as patient advocacy bodies. From the process, seventy relevant statements reached consensus. That number matters because it represents not the opinion of a single committee but a quantified, statistically tested convergence of more than 140 clinicians and advocates from different countries, disciplines, and healthcare systems. The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidance, approved by the Trinity College Dublin Faculty of Health Sciences Research Ethics Committee, and reported following established recommendations for conducting and reporting Delphi studies in palliative care.

So what did the experts agree on? At the core of the consensus is a clear statement of purpose: specialist palliative care services should support people with locally advanced or metastatic cancer for both cancer-related problems and problems arising from cancer treatment itself, alongside the holistic dimensions of care that address psychological, social, and spiritual suffering. The experts endorsed the involvement of a dedicated multidisciplinary team, reflecting the understanding that the needs of this population rarely fit within the competence of any single professional group. Pain, fatigue, neuropathy, lymphedema, anxiety, depression, financial strain, and existential distress can coexist in the same patient, and each demands a different kind of expertise.

This framing represents a significant conceptual shift. Specialist palliative care services have traditionally been organized around people approaching the end of life, with referral often triggered by decline rather than by the ongoing needs of patients who may live for years with stable metastatic disease. The consensus statements acknowledge that this group faces unique problems requiring different strategies. A patient whose disease is controlled on a targeted therapy may need help managing chronic treatment-related neuropathic pain, rehabilitation after surgery, or support returning to work, needs that differ substantially from those of a patient in the final weeks of life. The study’s findings will be used to inform a model of care designed to formalize this extended role.

Yet the experts were equally candid about the gaps. The consensus identified specific areas in which specialist palliative care services themselves require further training, including certain pain management strategies, psychological therapies, and the adverse effects of modern anticancer treatments. This admission is notable because it comes from within the specialty. As cancer treatment has evolved toward targeted agents, immunotherapies, and chronic oral regimens, the toxicities and long-term effects of these treatments have created clinical problems that traditional palliative care training, oriented toward symptom control at the end of life, did not necessarily cover. The study thus points to a two-way educational imperative: oncologists need to understand what specialist palliative care can offer earlier in the disease course, and palliative care specialists need to deepen their knowledge of contemporary oncological therapeutics.

The study also confronted the structural obstacles standing in the way of extending these services. Lack of resources emerged as a major barrier, a finding that will surprise no one working in European health systems where palliative care provision varies enormously between and within countries. Perhaps more insidiously, the experts identified misperceptions about specialist palliative care as a barrier to service extension. The persistent association of palliative care with death and dying means that patients and even referring physicians may resist involvement, fearing that a referral signals abandonment of active treatment. Previous research has documented how the naming of services, with some centers adopting the term supportive care in place of palliative care, reflects and reinforces these attitudes among oncology professionals. The new consensus statements provide an evidence-based counterweight: a formal, expert-endorsed description of what these services actually do for people living with advanced disease.

The methodological rigor underlying these conclusions deserves attention, because consensus studies are only as credible as the process that produces them. By pre-defining the consensus threshold at 75 percent, the researchers avoided the retrospective tuning of criteria that has undermined some Delphi studies. By testing stability between rounds with rank order correlation, they ensured that agreement reflected genuine convergence rather than fatigue or drift. The use of literature reviews to generate the initial statements grounded the exercise in published evidence rather than pure opinion, and the inclusion of patient advocacy organizations alongside clinical specialists brought the perspectives of those who use these services into the process. The study conformed to European data protection regulations and obtained informed consent from all participants.

The broader context makes the timing of this work significant. Recent years have seen growing international recognition that metastatic cancer survivorship is a distinct clinical domain. A 2022 National Cancer Institute meeting report in the United States addressed survivorship for individuals living with advanced and metastatic cancers, and subsequent work has called for a reconsideration of clinical care, policy, and research priorities for this population. Systematic reviews have documented extensive unmet supportive care needs among people with advanced cancer and their caregivers, and international standards and practice recommendations have been developed by the Multinational Association of Supportive Care in Cancer and the American Society of Clinical Oncology. What has been missing, the PRiSM investigators argue, is clarity about the specific role that specialist palliative care services should play within this evolving landscape, particularly in Europe where definitions and standards have been redefined through consensus processes in recent years.

The practical implications of the study extend well beyond academic debate. For health system planners, the seventy consensus statements constitute a blueprint for what a properly resourced specialist palliative care service for people with advanced cancer should look like, from the composition of the multidisciplinary team to the scope of physical and holistic interventions. For training bodies, the identified educational gaps define a curriculum for the specialty’s next generation. For oncologists and patients, the statements offer a shared, authoritative description of when and why to involve these services, potentially dismantling the misperceptions that currently delay referrals. And for researchers, the consensus provides a foundation on which models of care can be built and tested. As more people live longer with metastatic cancer, the question is no longer whether specialist palliative care has a role in their care, but how that role should be organized, staffed, and delivered. This European consensus gives the field its clearest answer yet, and the model of care that follows from it will determine whether the promise of longer survival is matched by a better quality of that survival.

Subject of Research: Expert consensus on the role of specialist palliative care services in the care of people with stable locally advanced or metastatic cancer

Article Title: PRiSM project: e-Delphi study on the role of specialist palliative care services in the care of people with stable locally advanced or metastatic cancer

Article References: Taylor, A., Davies, A., PRiSM e-Delphi Group, Abela, J., Ahmedzai, S. H., Antonuzzo, A., Aquilano, M., Solabarrieta, M. A., Arends, C., Arends, J., Baird, A.-M., Balding, L., Bana, M., Gimeno, E. B., Barry, C., Bergqvist, J., Boland, J., Boland, L., Bouleuc, C., … Sarmento, T. (2026). PRiSM project: e-Delphi study on the role of specialist palliative care services in the care of people with stable locally advanced or metastatic cancer. Supportive Care in Cancer, 34(10), Article 982. https://doi.org/10.1007/s00520-026-11211-x

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11211-x

Keywords: palliative care, metastatic cancer, e-Delphi study, cancer survivorship, supportive care, oncology, consensus statements, multidisciplinary team, symptom management, advanced cancer, Europe, model of care