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Crit Rev Oncol Hematol. 2018 Nov;131:90-95. doi: 10.1016/j.critrevonc.2018.09.002. Epub 2018 Sep 10.

Supporting Supportive Care in Cancer: The ethical importance of promoting a holistic conception of quality of life.

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Medical School & Wellcome Centre for Cultures and Environments of Health, University of Exeter, UK. Electronic address:
European School of Oncology and IEO European Institute of Oncology IRCCS, Milan, Italy. Electronic address:
Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università di Ferrara, Italy. Electronic address:


Advances in anticancer therapies and increasing attention towards patient quality of life make Supportive Care in Cancer (SCC) a key aspect of excellence in oncological care. SCC promotes a holistic conception of quality of life encompassing clinical, ethical/existential, and spiritual dimensions. Despite the calls of international oncology societies empirical evidence shows that SCC has not yet been implemented. More efforts are needed given the clinical and ethical value of SCC not only for patients, but also for clinicians and hospitals. Drawing on different literature sources, we identify and discuss three important barriers to the implementation of SCC: 1) organisational - lack of adequate resources and infrastructures in over-stretched clinical environments, 2) professional- burnout of cancer clinicians; and 3) cultural - stigma towards death and dying. We add an ethical counselling framework to the SCC implementation toolkit- which, could offer a flexible and resource-light way of embedding SCC, addressing these barriers.


Cancer; Ethical counselling; Illness trajectory; Implementation; Palliative care; Supportive care

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