Many people hear the word “palliative care” and think there’s nothing more that can be done. That’s not the case. This guide explains what palliative care really is, when it’s considered, and how to request it through the public health system. Straightforward, but calm.
What Is Palliative Care?
Palliative care improves the quality of life for patients and their families when facing the physical, psychological, social, or spiritual challenges of a serious illness. It also improves the quality of life for caregivers.
It is provided by a team: doctors, nurses, psychologists, social workers, and, depending on the setting, other professionals. They address what cancer treatment doesn’t always cover: pain, nausea, fatigue, anxiety, family concerns, or practical problems at home.
Palliative care does not treat the tumor. It treats the person. It can be provided at any stage of the cancer journey.
What It IS NOT
- It is not just “the end.” The Spanish National Health System’s (SNS) Palliative Care Strategy promotes an approach that goes beyond the terminal phase. End-of-life care is one part of palliative care, not the whole of it.
- It does not mean stopping treatment. While receiving palliative care, people can continue to see their regular medical team and receive treatment. You will continue to see your oncologist and undergo chemotherapy if that is appropriate for you.
- It has nothing to do with euthanasia. The AECC states this clearly: palliative care has no connection to euthanasia or assisted suicide.
Watch out for a very common misunderstanding
In oncology, “palliative” is also used to describe treatments aimed at controlling the disease rather than curing it. For example, chemotherapy for stage IV cancer (we explain this in the guide on stage IV). The SEOM notes that palliative and supportive treatments are often the same. That’s why it’s a good idea to ask: “Are you talking about palliative treatment for the tumor or a palliative care team?” They are different things and can go hand in hand.
Some palliative treatments for colon cancer are local. Sometimes a stent is placed in the tumor to prevent the intestine from becoming blocked. Radiation therapy can also be used for palliative purposes on the tumor or on metastases. When curative surgery isn’t possible, palliative surgery or other palliative treatments may be attempted.
When do they begin?
The short answer: sooner than many people think.
- The ASCO guidelines (updated in 2024) recommend referring patients with advanced solid tumors to specialized palliative care teams from the onset of the disease, alongside cancer treatment. They suggest involving these teams early on, especially if there are uncontrolled symptoms or concerns about quality of life.
- In Spain, the Ministry of Health’s palliative care guidelines for primary care state that palliative care should begin in the early stages of a life-threatening illness, concurrently with active treatments.
- The WHO adds that early palliative care reduces unnecessary hospitalizations.
Advanced colon cancer encompasses a wide range of situations. Some people with metastases have been undergoing treatment for years and are doing well. There is no set date to begin. There are times when it makes sense to consider it:
- when there are symptoms that are difficult to control (pain, vomiting, severe fatigue);
- when the emotional impact on you or your family is overwhelming;
- when the disease is progressing or treatments are no longer working;
- when you need help deciding what you want and what you don’t want.
The Ministry of Health outlines the general criteria for palliative care programs. These include an incurable, advanced, and progressive disease with a limited life expectancy and little chance of responding to specific treatments. They also take into account the intense emotional and family impact and the repercussions on the caregiver. These criteria guide the services, but you don’t have to meet all of them to request help with your symptoms.
A word of caution: in theory, it’s supposed to happen “early,” but in practice, it depends on your hospital and your community. That’s why it’s helpful for you or your family to request it.
What the team can do for you
- Manage symptoms: pain, nausea, loss of appetite, fatigue, constipation, or others. Medication adjustments are always decided by your care team.
- Emotional support for you and your family, including grief counseling if needed.
- Practical help: coordinating with the hospital, health center, and social services.
- Discussing what matters to you: where you want to be, what concerns you, and what you’d like to avoid. This ties into your advance care planning document (we have a guide on this).
How It Works in the National Health System
Palliative care is part of the public health system. The National Health System (SNS) Strategy serves as the common framework for organizing palliative care in Spain, ensuring equitable, comprehensive, and high-quality care. A 2026–2030 implementation plan was approved by the Interterritorial Council on April 9, 2026, although it is currently in draft form, pending the final version.
Each autonomous community organizes itself in its own way. The names vary: in some communities, they are called ESAD (home care support teams); in Catalonia, PADES; and in Madrid, there is a specific 24-hour palliative care service available every day of the year (PAL24). Home care support teams handle complex situations at home, in collaboration with primary care. In other cases, support comes from a hospital team or an inpatient unit. The Ministry publishes a map of resources detailing what is available in each autonomous community.
This is not usually a separate payment. It is part of the National Health System (SNS). The WHO considers palliative care a human right and a moral imperative for all health systems. The fact that it is recognized does not prevent differences in access between regions. If you encounter problems, the second-opinion guide and your medical record can help you with the paperwork.
How to Request Them
- Tell your oncologist: “I’d like to be seen by the palliative care team to better manage my symptoms.” It’s a normal request and doesn’t mean you’re giving up.
- If you’re unsure, talk to your family doctor or your nurse at the health center. Primary care also provides basic palliative care.
- Ask about the practical details: who your point person is, what number to call, and who to contact after hours. The Primary Care guidelines emphasize that you need to know who to call, how, and when, with written guidelines.
- Bring someone with you if you can. Write down your questions beforehand.
Don’t be afraid to ask questions like: “What can I expect?”, “What symptoms might I have?”, or “What should we do if my condition worsens at home?” You have the right to honest information—and also to choose how much you want to know.
When to notify your care team or go to the emergency room
Every case is different, and your care team will provide you with a plan. As a general rule, don’t wait until your next appointment if you have:
- pain that doesn’t go away with the medication you’ve been prescribed;
- vomiting that won’t stop, or a very swollen and painful abdomen with an inability to pass gas or stool (this could be a bowel obstruction);
- heavy bleeding;
- a fever if you’re undergoing chemotherapy (this is a medical emergency—see the guide on febrile neutropenia);
- new-onset confusion, drowsiness, or agitation;
- anxiety that you can’t cope with.
If something scares you or feels overwhelming, call. That’s what the teams are there for. In a serious situation or one you can’t handle, call 112 or go to the emergency room. If you have a palliative care plan, show the report to the emergency room staff.
Palliative Sedation: What It Is and What It Isn’t
It’s a scary topic, and it’s important to clarify it. SECPAL defines it as administering medications to reduce consciousness to the extent necessary to relieve symptoms that do not subside with other measures, in advanced or terminal illness. It’s used only in specific cases and with consent (yours, or that of your representative if you’re unable to give it). Inexperienced professionals may mistake it for a covert form of euthanasia, but it isn’t. If you’re concerned, discuss it with your care team well before you need it.
For the Family
Palliative care is also for caregivers. If you’re a caregiver and feeling exhausted, check out our guide on caring for the caregiver. And if you’re unsure how to provide support, there’s a guide on what helps and what doesn’t. For financial assistance, leave, and social resources, consult the guide to financial and social assistance.
The AECC has played a historic role in Spain. It is one of the pioneering organizations in caring for people with terminal cancer and their families. Over time, the Spanish National Health System (SNS) has gradually taken over this care, and the AECC’s units have been scaled back. Even so, patient associations can provide guidance and support.
The Essentials
- Palliative care = extra support to help you and your family live better.
- It can be provided alongside cancer treatment.
- It’s best not to wait until the end—ask early.
- Access depends on your region and your hospital. Ask for it clearly.
- Write down who to call and what to do if your condition worsens.
This guide is for informational purposes only and is not a substitute for your medical team. Decisions about your medication and treatment are always made by your oncologist and your palliative care team.