Survivorship, Palliative Care, and Ethics
Core concepts
Survivorship: surveillance schedules by cancer type, late effects of therapy (cardiotoxicity, secondary malignancies, infertility, neuropathy, lymphedema), psychosocial screening, and health maintenance (vaccines, bone health, exercise). Palliative care: symptom management (pain, dyspnea, nausea, constipation), opioid principles, goals-of-care conversations, and the evidence that early palliative care improves quality of life. Ethics: informed consent and decision-making capacity, advance care planning, do-not-resuscitate orders, confidentiality, and resource allocation. Recognize futility discussions, surrogate decision-making standards, and cultural humility. Understand hospice eligibility and the difference between palliative care and hospice.
Traps
Questions test whether you would recommend hospice versus continued disease-directed therapy, how to assess decision-making capacity, and the correct surrogate standard (substituted judgment vs best interests). Watch for conflating palliative care with end-of-life care and for opioid dosing conversions.
Rule of thumb
Palliative care is appropriate at any point in serious illness and alongside curative treatment; hospice requires a prognosis of six months or less if the disease runs its natural course.
Worked example
A patient with advanced cancer and uncontrolled pain: optimize analgesia and involve palliative care early; this improves quality of life and does not preclude ongoing therapy.