Ten years palliative care in Europe: the good, the bad, and the ugly?

Prof Dr Wim J.A. van den Heuvel, Chairman of International Editorial Board of PALIAŢIA

The conference ‘Oncology in Medical Practice’, held in Bucharest 21-23 March 2019, presented a multidisciplinary and international perspective on health care. Medical practice has always been based on a multidisciplinary approach and also needs an interdisciplinary approach. This is what the Bucharest conference demonstrated. And such an approach is inevitable when it comes to palliative care. Indeed, it is an international trend. End of April 2019 the NYU School of Medicine organizes its annual Interdisciplinary Palliative Care Conference (1). Indeed annually, because we still have much to learn and to do better!

For example, how likely are oncologists to refer for palliative care? A recent study answers this question: it depends from their age! (2) Another study on ‘curable and incurable cancers’ states that in the coming decade the number of cancer survivors will strongly increase (3). Good news!

Ten years ago (October 2009), an international workshop was organized in Bucharest, entitled ‘’Palliative care for Romanian citizens: a plan for action’’ to discuss the needed steps to realise palliative care in Romania. One of the speakers was Dr. Wodarg, who initiated the resolution in 2009 in the Council of Europe to realise ‘’Palliative care: a model for innovative health and social policies’’. Recently the Council of Europe launched its latest report on palliative care in Europe (see News). The report supports former findings, which show that palliative care is not properly introduced in various European countries and often is not seen as an essential component of health care. The report calls for action again!

Another recent report concludes, that palliative issues are inadequately addressed among hospitalized cancer patients (4). Bad news!

What action? How to deliver proper palliative care? What will make palliative care policy change for the better after ten years? It will become even more complicated! The number of cancer survivors will increase, but studies on metastatic cancer survivors are rare. We are not prepare to answer questions as recently raised by Langbaum and Smith (3): are healthcare systems prepared to care for long-term cancer survivors (expertise, personnel, and costs)?

How will each country deal with the exponential growth in needed facilities, expertise and costs of treatment for longer durations of survival? How to realise such challenges without palliative care? The ugly!


  1. Interdisciplinary Palliative Care Conference. [Available from nyulmc.org/palliativecme]. Accessed at 19.03.2019
  2. Hui D, Kilgore K, Park M, et al. Pattern and predictors of outpatient palliative care referral among thoracic medical oncologists. Oncologist 2018;23:1230-1235.
  3. Langbaum T, Smith TJ. Time to Study Metastatic-Cancer Survivorship. N Engl J Med 2019; 380:1300-1302
  4. Newcomb R, Nipp RD, Chan AT, et al. Symptom burden in hospitalized patients with curable and incurable cancers. Oral presentation at: 2018 ASCO Annual Meeting; June 1-5, 2018; Chicago, IL.