Key takeaways:

• Less than 20% of young adults with advanced cancer receive guideline-recommended palliative care along with active treatment.
• Patients with lung and gastric cancers have the highest utilization rates.

More than 80% of young adults with advanced cancer do not receive guideline-recommended palliative care along with systemic treatment despite utilization doubling between 2010 and 2023.

Patients with lung, gastric and kidney cancers received concurrent palliative care at the highest rates, whereas those with Hodgkin and non-Hodgkin lymphoma and poor-prognosis brain tumors had the lowest usage.

Data derived from Shi KS, et al. JAMA Netw Open. 2026;doi:10.1001/jamanetworkopen.2026.24907.

“Palliative care should be integrated earlier and more consistently as part of routine cancer care for young adults with advanced disease,” Kewei S. Shi, MPH, associate scientist and health services researcher at American Cancer Society, told Healio.

“Palliative care is not limited to end-of-life care and should be provided alongside cancer-directed treatment. Clinicians and health systems should regularly assess patients’ symptoms and supportive care needs and connect them with appropriate services. Integrating basic palliative care into routine oncology care, while referring patients with more complex needs to specialty palliative care, may help expand access.”

‘Appropriate cancer care’

All patients with advanced cancer should be referred to palliative care, which can be delivered early in the disease course, including during active treatment, according to ASCO guidelines.

Many populations do not receive services, though.

Healio previously reported nearly half of patients with high-risk brain metastases do not receive consultations.

Another study showed less than 10% of individuals with diffuse large B-cell lymphoma received palliative care consults.

“However, little was known about how frequently young adults with advanced cancer receive palliative care as part of their cancer treatment or how utilization has changed over time,” Shi said. “Cancer incidence among young adults has been increasing in recent years in the United States, making it increasingly important to understand whether this population is receiving appropriate cancer care.”

The retrospective investigation included 67,706 patients (51.9% women) aged 18 to 39 years (median age, 33 years; interquartile range, 28-37) diagnosed with first primary stage IV solid cancers (n = 62,072) or poor-prognosis high-grade brain tumors (n = 5,634) between 2010 and 2023.

Use of palliative care served as the primary endpoint.

‘Low’ utilization

Concurrent palliative care utilization increased from 9.3% in 2010 to 18.3% in 2023.

“We were encouraged to see that palliative care use alongside systemic treatment increased over time,” Shi said. “However, utilization remained low. Given the complex needs for patients with advanced cancer, we expected use to be higher.”

Between 2021 and 2023, 17.1% of patients received concurrent palliative care, but substantial variation existed among malignancy types.

Those diagnosed with lung cancer had the highest usage (39.1%), followed by gastric (32.6%), kidney (29.9%), female breast (28.2%) and pancreatic cancers (27.6%).

Malignancies with the lowest utilization included Hodgkin (1.9%) and non-Hodgkin lymphoma (4.1%), poor-prognosis brain tumors (4.3%) and head and neck cancers (4.4%).

“[These data] suggest that receipt may depend partly on symptom burden, specialty clinician factors, or care setting rather than patients’ full supportive care needs,” Shi said.

Researchers acknowledged study limitations, including evaluating palliative care during initial treatment, which could underestimate overall use.

“Future research should examine palliative care use within specific cancer types and explore the patient-, clinician-, treatment-, health system- and policy-level factors that influence whether young adults receive these services,” Shi said.

“Another important challenge is that palliative care is not consistently or comprehensively captured in many existing cancer registry data sources. We need better and more standardized data on when palliative care is initiated, what services are provided, who delivers them and how frequently patients receive them,” she added. “Improving palliative care measurement and documentation would allow researchers to evaluate the quality and timing of care more accurately and identify strategies to expand access for young adults who may benefit from receipt of palliative care.”

For more information:

Kewei S. Shi, MPH, can be reached at sylvia.shi@cancer.org.