Early integration of palliative, or supportive, care at the time of breast cancer diagnosis improved quality of life more than on-demand palliative care in a randomized trial of patients in India. The research was highlighted in a media briefing ahead of the 2026 ASCO Breakthrough Meeting, taking place June 25 to June 27 in Singapore.
The prospective trial enrolled 110 patients newly diagnosed with breast cancer at a single hospital in India, most of whom had advanced-stage disease. Patients were randomly assigned to early integrated palliative care or on-demand palliative care. The early integration group included 56 patients, and the on-demand group included 54 patients.
“Until now, no randomized trial from a low- or middle-income country had quantified, in breast cancer specifically, how much quality of life improves when supportive care is started at diagnosis rather than after curative options run out,” said study author Himanshu Varshney, MD, of Dr. B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi. “Our trial fills that gap and provides directly actionable data for breast cancer care pathways in resource-limited settings.”
Early Integration vs On-Demand
Patients in the early integration group received a palliative care referral within 1 week of diagnosis, with consultations at least once a month alongside standard breast cancer treatment. Patients in the on-demand group received palliative care only when requested by the patient, family, or physician, or when standard breast cancer treatments stopped working.
In both groups, palliative care consultations included symptom assessment and management, psychosocial support and counseling for patients and families, education about breast cancer and its treatment, care coordination, and caregiver support.
Quality of life was measured using the Global Health Status measure from the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. Overall symptom burden was measured using the Total Symptom Distress Score from the Edmonton Symptom Assessment System. Patients completed both assessments at baseline and again at 3 months.
Study Results
Among the 110 enrolled patients, 94 patients (85.5%) completed the 3-month assessment and were included in the analysis. Global Health Status scores improved by 23.2 points in the early integration group vs 14.7 points in the on-demand group. A 23-point improvement is considered clinically meaningful, wherein the integration of palliative care produced a noticeable difference in participants’ lives.
About 70% of patients in the early integration group experienced a meaningful improvement in overall quality of life, compared with 54% in the on-demand group. In addition, 39% of patients in the early integration group achieved a reliable, clinically significant improvement that moved their Global Health Status scores from the impaired range into the normal or functional range, compared with 6% of patients in the on-demand group.
Overall symptom burden also decreased more with early integrated palliative care. Total Symptom Distress Scores fell by 28.3 points in the early integration group vs 21.1 points in the on-demand group. The largest difference was seen in social functioning, which improved by 25.5 points in the early integration group and decreased by 3.9 points in the on-demand group.
The researchers plan to assess outcomes again at 6 and 12 months to determine whether the quality-of-life benefits persist. They also plan to evaluate whether early palliative care affects survival and to conduct a formal cost-benefit analysis.
Expert Perspective
“This study addresses a critically important and often underappreciated aspect of breast cancer care: the early integration of palliative, or supportive, care alongside active treatment. These results reinforce that early palliative care should be considered a standard component of high-quality breast cancer care,” said Rebecca Alexandra Dent, MD, Deputy Chief Executive Officer (Clinical) and Senior Consultant at the National Cancer Centre Singapore and an ASCO Expert in breast cancer. “The challenge moving forward will be implementation—ensuring access to trained palliative care teams and integrating these services efficiently into oncology workflows, particularly in resource-constrained settings.”
Disclosures: This investigator-initiated academic study had no external industry funding. For full disclosures of the study authors, visit coi.asco.org.
