Early integrated palliative care improved quality of life for patients with newly diagnosed incurable cancers, found a recent study.1

Researchers randomly assigned patients with newly diagnosed incurable lung or noncolorectal GI cancer to receive either early integrated palliative care and oncology care, or usual care. Patients assigned to the intervention met with a palliative care clinician at least once a month until death; those who received usual care consulted with a palliative care clinician upon request. Some key findings include the following:

  • Intervention patients with lung cancer reported improvements in quality of life and depression at 12 and 24 weeks, whereas usual care patients with lung cancer reported deterioration.
  • Patients with GI cancers in both study groups reported improvements in quality of life and mood by week 12.
  • Intervention patients versus usual care patients were more likely to discuss their wishes with their oncologists if they were dying.

“We were surprised that the effect of the early palliative care was different in patients with lung and GI cancer,” says Jennifer S. Temel, MD, the study’s lead author. Temel is clinical director of thoracic oncology at Massachusetts General Hospital in Boston.

This suggests that patients with different cancers may have different support care needs. For example, patients with GI cancer are more likely to be admitted to the hospital. This group of patients may need more intensive palliative care services during hospitalizations.

“Palliative care is an essential component of cancer care for patients with advanced cancer,” says Temel. An important aspect of palliative care is the focus on communicating with patients about their prognoses and end-of-life care preferences.

“In this study, patients who were assigned to early palliative care were twice as likely to report that they discussed their end-of-life care preferences as those receiving oncology care alone,” says Temel.

Now Standard of Care

Palliative care is “now standard of care,” and the regulatory expectation is that it be available in all healthcare systems, says David A. Fleming, MD, MA, MACP, co-director and scholar at the MU Center for Health Ethics in Columbia, MO.

“Well applied, it does improve quality of life for patients suffering from cancer and other forms of terminal illnesses,” says Fleming. Similarly, hospice care has been demonstrated to improve both longevity and quality of life in dying patients.

“This is due to the knowledge and skills of specialists, plus the detailed attention and support both patients and caregivers receive by those trained in end-of-life care,” says Fleming.

One barrier to implementing such specialized care early, when it can be most effective, is that patients, families, and even healthcare teams are in denial that treatment may be futile and death imminent. “This is coupled with pernicious hope that cure, or at least delay, of the disease may yet be possible, regardless of clinical facts and prognosis,” says Fleming.

Care teams, especially in oncology, may hesitate to offer palliative care, fearing that dampening hope may cause depression in patients and negatively influence response to treatment.

“Unnecessary suffering may ensue because the optimal full complement of care and treatment — including palliative and hospice care — are often withheld from patients who might otherwise gain benefit,” says Fleming.

REFERENCE

  1. Temel JS, Greer JA, El-Jawahri A, et al. Effects of early integrated palliative care in patients with lung and GI cancer: A randomized clinical trial. J Clin Oncol 2017; 35(8):834-841.

SOURCES

  • Jennifer S. Temel, MD, Director, Cancer Outcomes Research Program, Massachusetts General Hospital, Boston. Phone: (617) 724-4000. Email: jtemel@partners.org.
  • David A. Fleming, MD, MA, MACP, Co-Director and Scholar, MU Center for Health Ethics, Columbia, MO. Phone: (573) 882-2738. Fax: (573) 884-2664. Email: flemingd@health.missouri.edu.