The Multinational Association of Supportive Care in Cancer (MASCC) defines supportive care as “the prevention and management of the adverse effects of cancer and its treatment. This includes management of physical and psychological symptoms and side effects across the continuum of the cancer journey from diagnosis through treatment to post-treatment care. Supportive care aims to improve the quality of rehabilitation, secondary cancer prevention, survivorship, and end-of-life care”. This article will provide an overview of modern supportive care in cancer, discussing its definition, its relationship with palliative care, models of care, “core” service elements (multi-professional/multidisciplinary involvement), the evidence that supportive care improves morbidity, quality of life, and mortality in various groups of patients with cancer, and the health economic benefits of supportive care. The article will also discuss the current and future challenges to providing optimal supportive care to all oncology patients.

Palliative care has traditionally focused on end-of-life care for patients with advanced cancer. This has since expanded to include symptom management and quality-of-life improvement from the moment of cancer diagnosis. Specialist palliative care teams work across community and inpatient settings and focus on dealing with complex problems whilst supporting healthcare colleagues in providing generalist palliative care. This article will outline the principles of palliative care, models of palliative care delivery, the distinctions between palliative care and supportive care, and the role of specialist palliative care in cancer survivorship.

Palliative care is the active holistic (physical, psychological, social and spiritual) care of people who experience health-related suffering due to severe illness and those close to them, aiming to improve their quality of life. There are three levels of palliative care: palliative care approach, generalist palliative care, and specialist palliative care. Traditionally associated with end of life care, this article highlights the evolution of specialist palliative care, now deemed to be applicable throughout the course of an illness. Terminologies surrounding "palliative care" are also considered, especially the notable nomenclature debate between "palliative care" and "supportive care". Specialist palliative care has evolved somewhat over time, and will need to continue to evolve to maintain its relevance.

Purpose: Definitions of “cancer survivors” vary from individuals from diagnosis throughout their life, to individuals post-curative intent treatment. Attempts to categorise groups of people who have or had cancer also differ. This study aims to generate European expert consensus opinion about cancer survivor terminology and categorisation relevant to developing a model of care. Methods: This was an electronic Delphi study where specialist palliative care (SPC) and oncology (ONC) European experts, including patient advocates, were purposively sampled to form two separate groups. Participants selected agreement with 105 questions/statements developed from literature reviews in round 1, and in subsequent rounds statements were modified/added according to feedback. The study was terminated when consensus (pre-defined as ≥ 75% within each group) and stability (determined by Spearman’s Rank Order Correlation) were reached for most statements. The Chi square test for goodness of fit compared agreement between groups. Results: Eighty-six SPC experts from 19 countries/regions, and 54 ONC experts from 17 countries/regions began the process, with three rounds completed by 80 and 49 respectively. Eight statements about “cancer survivor” application reached consensus in both groups, demonstrating agreement that “cancer survivor” should be applied to people post-treatment with no evidence of disease. Two other statements reached consensus in only one group (with a significant difference). Two categorisations reached consensus in both groups. Conclusions: These experts suggest that application of “cancer survivor” to people with active cancer should be reconsidered. Implications for Cancer Survivors: Pragmatic categorisation of people who have/had cancer could help provide tailored care for different groups.

Background: Constipation is common in people with advanced cancer and is associated with significant morbidity and health economic burden, but it is often sub-optimally managed. Despite international consensus diagnostic criteria for functional and opioid-induced constipation (Rome IV diagnostic criteria), the term ‘constipation’ means different things to different people, impacting assessment, diagnosis and management. Aim: To investigate the association between persons with advanced cancer self-reporting of constipation, response to the Rome IV diagnostic criteria statements for opioid-induced constipation and differences according to personal demographics. Design: Multicentre prospective observational study. Setting/participants: Twenty-four community, hospice and hospital research sites in 10 European countries recruited 1200 adults with cancer taking opioids for cancer/cancer-treatment related pain. Results: In response to the simple question ‘Are you constipated?’ , 549 (45.5%) participants replied ‘yes’, 588 (49%) replied ‘no’ and 59 (5%) were ‘unsure’, but 713 (59.5%) participants met the Rome IV diagnostic criteria. Only 439 (61.5%) participants that met these criteria answered the simple question positively, whilst 230 (39%) answered negatively, although there was a statistically significant association between responses to the simple question and the criteria (χ ² (1, N = 1136) = 149.945, p = 0.00001). There were certain significant differences in self-reporting according to age and country of origin. Conclusions: There is disparity between patients’ self-reporting of constipation and the Rome IV diagnostic criteria. People with advanced cancer, especially those receiving opioid analgesics, need to be regularly assessed for constipation, but the use of a single question ( ‘Are you constipated?’ ) is inadequate. Registry: European Study of Opioid Induced Constipation (E-StOIC), NCT05149833, https://clinicaltrials.gov/study/NCT05149833 , 08/12/2021.