Bridging urology and palliative care: a narrative review of current practice and evolving priorities

This narrative review summarizes recent evidence (2023-2025) on the role of palliative care in urology. It focuses on utilization trends, access disparities, symptom burden, procedural palliative needs, and end-of-life (EOL) care in advanced genitourinary malignancies.

PC utilization in genitourinary cancers is increasing. Inpatient palliative care use rose from 4.9 to 31.5% in renal cell carcinoma and from 5.9 to 19.0% in testicular cancer. Yet, integration into routine care remains inconsistent. Disparities persist, including lower palliative care utilization among certain ethnic groups and uninsured patients, and higher odds of receiving high-intensity EOL care among socioeconomically vulnerable populations. Symptom burden remains substantial, with up to 82% of patients reporting multiple symptoms. This underscores the need for more timely palliative care involvement and more standardized reporting. Communication gaps, particularly regarding prognosis and EOL preferences, highlight opportunities for urologists to engage more actively in initiating palliative care discussions. Procedural palliative needs, including malignant ureteral obstruction management, illustrate the direct impact of urologists in providing symptom-directed palliative care.

Despite growing recognition of palliative care gaps remain in access, referral timing, and systematic assessment. Addressing disparities, enhancing interdisciplinary collaboration, and prioritizing prospective research will be essential to improve patient and caregiver-centered outcomes.