Early Initiation of Palliative Care Improves Overall Wellbeing in Patients with Incurable Cancer

Individuals with terminal gastrointestinal or lung cancer who receive early integrated palliative care saw improvement in quality of life, better ability to cope with prognosis, reduction in depression, and better communication of end of life preferences.

Investigators enrolled 350 adult patients within 8 weeks of being diagnosed with incurable lung and noncolorectal gastrointestinal cancer. The lung cancer subtypes were non—small cell lung cancer (NSCLC), small-cell, or mesothelioma, whereas the gastrointestinal cancers included esophageal, gastric, hepatobiliary, and pancreatic types.

In the study published in theJournal of Clinical Oncology, participants were randomized to receive either early integrated palliative care and oncology care or usual care between May 2011 and July 2015.

Participants placed in the intervention group met with a palliative care clinician at least once per month until death. Individuals in the control arm received usual care and only consulted with a palliative care clinician upon request.

To measure quality of life, the investigators used the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) scale, which assesses emotional, physical, functional, and social well-being.

Study participants were required to complete the Patient Health Questionnaire-9 and the Hospital Anxiety and Depression Scale to assess mood and anxiety.

The primary outcome was defined as a change in quality of life from baseline to week 12. Secondary endpoints included changes in quality of life from baseline to week 24, changes in depression, and differences in end-of-life communication.

In the intervention group, the mean number of palliative care visits was 6.54 per 24 weeks in the intervention group and 0.89 visits per 24 weeks in the usual care group.

The results of the study showed that patients in the intervention arm had significantly greater improvement in quality of life from baseline to week 24 than did the patients in the usual care group. However, the difference was not significant from baseline to week 12. Patients in the intervention group also reported lower depression at week 24.

Individuals with lung cancer who received a minimum of monthly palliative care consultations reported improvements in quality of life and depression at 12 and 24 weeks, whereas patients with lung cancer in the usual care group reported deterioration, according to the study.

There were twice as many patients in the intervention group (both cancer types) who discussed their wishes with their oncologists compared with the control group.

“While palliative care clinicians are certainly experts in symptom management, our data shows that they also focus on helping patients with advanced cancer cope more effectively with their cancer,” Jennifer S. Temel, MD, toldHemOnc Today. “We show that patients receiving early integrated palliative care were more likely to report that knowing about their prognosis helped them cope with their illness and make decisions about their care. Palliative care also helps patients engage in conversations about their goals and values, both as they navigate their cancer diagnosis and near the end of life.”

The investigators observed that the content discussions around palliative care changed according to the trajectory of the disease, as did the needs of the patient and their family.

“We show that during the first 6 months after diagnosis, palliative care focuses predominately on assessing and managing symptoms and on addressing and offering strategies for copying with their illness,” Temel toldHemOnc Today. “During this time [palliative care clinicians] also focus on establishing relationships with patients and their families and helping them understand their diagnosis and its likely trajectory.”

Limitations to the study were that it was not a double-blinded study, differences in quality of life cancers were unexpected, and more than one-third of patients in the usual care arm met with palliative care clinicians in the first 24 weeks of the study.

“This study provides further and novel evidence for early integrated palliative and oncology care for patients with advanced cancer and supports the recent ASCO 2016 Clinical Practice Guideline Update on integration of palliative care,” Temel said.