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You already know palliative care isn’t an end-of-life intervention. It’s a proactive, evidence-based system that extends survival, preserves dose intensity, and minimizes avoidable treatment disruptions.
So, here's the real question:
How many of your patients drop off therapy - not due to progression, but because of toxicity, avoidable hospital stays, or conversations that happened too late?
If you're not tracking this systematically, you're losing outcomes - and margin.
Early Palliative Care: The Performance Multiplier in Modern Oncology
Advanced therapies - checkpoint inhibitors, ADCs, BiTEs - carry efficacy headlines but also complex AE profiles. Managing these toxicities is central to preserving dose intensity, preventing treatment discontinuation, and avoiding preventable morbidity.
The COCOON study (2025) is a masterclass in this approach.
Faced with predictable high-grade dermatologic toxicities from the anti-EGFR regimen, clinicians implemented a prophylactic regimen- oral antibiotics, topical corticosteroids, barrier creams. The result? A 50% reduction in Grade ≥2 events and a significant drop in discontinuations.
This wasn’t innovation for innovation’s sake. It was integrative palliative care - anticipatory, embedded, and outcome-driven.
Imagine applying that same mindset across immunotherapy-induced colitis, ADC-related cytopenia, or pneumonitis and mucositis - a far too common reality for patients dealing with cancer.
Identify patients at risk, trigger prophylactic or early management.
The opportunity isn’t just to reduce side effects - it’s to extend progression-free survival by keeping patients on the therapies designed to help them.
Leading practices don’t "add" palliative care - they embed it to:
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Keep patients eligible for advanced therapies
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Prevent unplanned care that derails treatment
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Align care delivery with patient tolerance and goals
This isn’t theory. It’s operational discipline.
The data are Clear. ASCO Guidelines (2024) also recommend early palliative care as a now standard alongside active treatment.
Yet 90% of patients still miss out - because late-stage consults remain the norm. That drives avoidable drop-offs, higher acute care costs, and missed financial performance.
Early palliative care needs to be designed into care pathways from Day 1.
How Leading Practices Operationalize Early Integration
They design lean, scalable systems - embedding value without adding complexity:
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Trigger-Based Symptom Algorithms: Automate toxicity escalations via PROs/ ePROs and EHR alerts - intervene before an ER visit.
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APPs as Care Integrators: Upskill the APPs towards structured goals-of-care, symptom management, and CMS-aligned billing (99497, 99490).
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Tele-Palliative Partnerships Without Overhead: Hybrid models for complexity management - no overhead, no delays.
Reimbursement Pathways You Should be Capturing:
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99497 / 99498: Advance Care Planning
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99490 / 99491: Chronic Care Management
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99358 / 99359: Prolonged Services
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G2211: Visit Complexity Add-On
If you’re not leveraging these codes, you’re missing care continuity - and margin.
What Operational Excellence Looks Like
1. Automate EHR alerts
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≥2 PRO-CTCAE Grade 2 symptoms (e.g., neuropathy, diarrhea)
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7-day unscheduled contact (portal messages, nurse calls)
2. APP-led workflows
3. Tele-palliative escalation
4. Overcome barriers
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Workforce shortages: Partner with specialized partners for after-hours tele-palliative coverage (eg. Carecentrix, ReSolution Care).
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Referral reluctance: Embed palliative APPs in tumor boards (↑ consults by 300%).
5. Track in real-time via EHR dashboards:
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Measuring What Matters (MWM): 10 core metrics from AAHPM/HPNA, including symptom screening and care consistency.
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CAPC Metrics: Operational (LOS, mortality), clinical (symptoms), and financial (cost/case-mix index).
👉 View a list of sample metrics that you may consider here.
If this workflow is not your setup yet, it’s not a resource gap - it’s a design gap.
In oncology today, survival depends as much on sustaining therapy as selecting it. Top practices build for both.
Already embedded Early Palliative Care? Lead the Next Frontier
If you’ve integrated early palliative care into your workflow - congratulations. But leading practices don’t stop at meeting standards. They define what's next.
Now is the time to evolve from early palliative care to a truly integrative model - one that sustains therapy and elevates patient experience across the continuum of care.
Patients deserve whole-person care aligned with evidence-based, lifestyle-centered interventions. And it's more than likely they are already asking for it.
This isn’t alternative medicine.
It’s adjunctive, data-backed care that enhances outcomes.
Integrative Strategies That Deliver:
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Acupuncture: Proven efficacy in managing cancer-related and neuropathic pain.
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Exercise Oncology: Meta-analyses show improvements in quality of life, fatigue, insomnia, physical & social function, dyspnea in advanced cancer patients
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Low-Intensity Therapies: Walking, Tai Chi, Qigong, and yoga significantly reduce cancer-related fatigue - without burdening frail patients.
These interventions are measurable enhancers of patient resilience, therapy adherence, and overall satisfaction.
The Bottom Line
Early palliative care is your operational foundation. Integrative care is your next differentiator.
Embed both - not as a reaction. Not when things deteriorate.
Now. By design.
Best,
Shruti Agarwal, PhD
Together4Cancer
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The Compass is your practical briefing on what’s working in oncology care - strategy, science, and systems. No fluff. Just implementation. |
