EXECUTIVE SUMMARY

When early palliative care is provided to patients with newly diagnosed cancers, family caregivers’ quality of life and mood improve, according to a recent study. Ethicists can facilitate early provision of palliative care with the following:

  • advocating for palliative care training in medical curricula,
  • referring patients early to palliative care, and
  • advocating for policy changes that ensure palliative care is offered very soon after diagnosis.

Early palliative care integrated with oncology care benefits not only patients with cancer, but also family caregivers, according to a new study.1

Researchers enrolled 350 patients with newly diagnosed incurable lung or gastrointestinal cancers and 275 family caregivers in the study. Half received usual oncology care, and half received usual care in addition to palliative care.

Family caregivers were not required to attend palliative care sessions, but more than half of them did. Family caregivers’ quality of life and mood were measured at baseline, 12 weeks, and at 24 weeks. The study’s key findings include the following:

  • After 12 weeks, caregivers reported fewer depression symptoms and improved vitality and social functioning compared to caregivers of patients receiving strictly medical care.
  • After 24 weeks, the lower rate of depression symptoms was persistent, but there was no difference observed in vitality and social functioning.

“Studies have shown that early palliative care helps patients live longer and feel better,” says VJ Periyakoil, MD, director of palliative care education and training at Stanford (CA) University School of Medicine.

Despite a growing body of evidence, most seriously ill patients are not being referred to palliative care. Primary care doctors, oncologists, and cardiologists may delay referral to palliative care because they’re uncertain about the patient’s anticipated life span, or because they believe that it is too early to refer.

“All seriously ill patients have the right to see a palliative expert, so they can avail themselves of the great benefits it provides to them and their family,” says Periyakoil.

Periyakoil says ethicists can promote increased access to palliative care for all seriously ill patients by the following:

  • advocating for palliative care training in medical curricula,
  • referring patients early to palliative care, and
  • advocating for policy changes that ensure palliative care is offered to all patients diagnosed with cancer, heart failure, kidney failure, dementia, ALS, and other illnesses very soon after diagnosis.

Amy S. Kelley, MD, MSHS, associate professor at Icahn School of Medicine at Mount Sinai’s Brookdale Department of Geriatrics and Palliative Medicine in New York City, says the study clearly demonstrates the importance of considering patients as people within the context of a family, however that unit is defined for that person.

“Palliative care should be provided at the same time as other components of high-quality medical care — at the time of diagnosis,” says Kelley.

The study’s findings demonstrate that family caregivers personally benefit from this added layer of support — either in addition to, or perhaps because of, the benefits experienced by patients. “Clinicians, including oncologists, should offer early palliative care routinely, and patients and families must know to ask for it,” says Kelley.

However, significant challenges remain in providing early palliative care to all seriously ill patients. One is that the palliative care work force is small and growing slowly. “It is vastly outpaced by the number of people needing services,” says Kelley. “Given the potential benefits for patients and families, overcoming these challenges is perhaps an ethical challenge.”

Palliative care programs have expanded in recent years, but access to high-quality palliative care remains limited in many areas of the country.

“Ethicists can play an important role in advocating for local, state, and federal support to help expand palliative care training, develop the needed workforce, and support research,” says Kelley.

REFERENCE

  1. El-Jawahri A, Jackson VA, Greer JA, et al. Early integrated palliative care improves family caregivers (FC) outcomes for patients with gastrointestinal and lung cancer. J Clin Oncol. 2016 (suppl; abstr 10131).

SOURCES

  • Amy S. Kelley, MD, MSHS, Associate Professor, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City. Phone: (212) 241-2631. Fax: (212) 860-9737. Email: amy.kelley@mssm.edu.
  • VJ Periyakoil, MD, Director, Palliative Care Education and Training, Stanford (CA) University School of Medicine. Email: periyakoil@stanford.edu.