Table 1. ASCO Framework of Resource Stratification:
Palliative Care
Setting Definition
Institutional
Level in some
LMICs for
Palliative Care
Basic Core resources or fundamental services that are
absolutely necessary for any cancer health care system
to function. Basic-level services typically are applied
in a single clinical interaction. (However, palliative
care is slightly different)
Primary Health
Care; Community
Limited Second-tier resources or services that are intended
to produce major improvements in outcome such as
increased survival, and are attainable with limited
financial means and modest infrastructure. Limited-
level services may involve single or multiple clinical
interactions.
District Level
facility
Enhanced ird-tier resources or services that are optional but
important. Enhanced-level resources should produce
further improvements in outcome and increase
the number and quality of therapeutic options and
patient choice.
Regional facility
Maximal • May use high-resource settings' guidelines.
• High-level/state-of-the art resources or services
that may be used/available in some high-resource
countries and/or may be recommended by high-
resource setting guidelines that do not adapt to
resource constraints but that nonetheless should
be considered a lower priority than those resources
or services listed in the other categories on the
basis of extreme cost and/or impracticality for
broad use in a resource-limited environment; to be
useful, maximal-level resources typically depend
on the existence and functionality of all lower
level resources. Health budgets still require hard
choices, and private insurers or public systems may
carefully ration access to the most costly therapies.
National Level
facility
NOTE: Data adapted. To be useful, maximal-level resources typically depend on the existence and
functionality of all lower-level resources.