09 Sep Early Palliative Care Improved Patients’ Symptoms and Coping Skills
MedicalResearch.com Interview with:
Joseph A. Greer, Ph.D.
Program Director, Center for Psychiatric Oncology & Behavioral Sciences
Associate Director, Cancer Outcomes Research Program,
Massachusetts General Hospital Cancer Center
Yawkey Center, Boston, MA 02114
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Many patients with advanced cancer have a high symptom burden, increased depression symptoms, misperceptions about their prognosis, and difficulties in making decisions about care at the end of life.
To address these challenges and improve care for this vulnerable population, our research team initially conducted a small, single-group pilot study of early palliative care integrated with standard oncology care for patients with advanced lung cancer.
This study showed that the model of integrated care was feasible and acceptable to patients and their families. Specifically, the majority of patients in the study were able to meet with a palliative care clinician at least monthly from the time of diagnosis of metastatic lung cancer, in order to receive help with managing symptoms as well as support for coping with the disease and making decisions about treatment. We then conducted a follow-up randomized controlled trial of early, integrated palliative care in a sample of approximately 150 patients with metastatic non-small cell lung cancer. This study was published in the New England Journal of Medicine in 2010 and showed that those patients who received early palliative care reported significantly improved quality of life, mood, prognostic awareness, and end-of-life care compared to those who received standard oncology care alone.
To confirm the findings of our prior research and to determine whether the benefits of early integrated palliative care would apply to a larger sample of patients with diverse malignancies, we recently completed another randomized trial of this same model of care in a sample of 350 patients with incurable lung and gastrointestinal cancers. In this trial, we observed that patients who received the early palliative care intervention reported higher quality of life and improved mood by 24 weeks but not at the primary end-point of 12 weeks. Our team was surprised to find that the trajectory of quality of life and depression symptoms over time was different for individuals with incurable lung versus gastrointestinal cancers in this study. As expected, the palliative care intervention positively buffered the decline in quality of life by 12 weeks for patients with incurable lung cancer, as we had seen in our prior trial. However, the group of patients with gastrointestinal cancers reported an improvement in their quality of life by the 12-week time point regardless of whether they received the palliative care intervention.
We are still exploring possible reasons for this difference, such as whether changes in cancer therapy may have reduced symptoms and improved quality of life in the group of patients with gastrointestinal cancer.
In addition, we were pleased to learn that the early integrated palliative care intervention led to improvements in how patients cope with their illness. For example, compared to patients in the usual oncology care group, those who received early, integrated palliative care were more likely to learn ways to accept their diagnosis and to take positive actions to make their lives better. So, in addition to treating patients’ symptoms, the palliative care clinicians in this study were bolstering people’s adaptive coping skills.
MedicalResearch.com: What should readers take away from your report?
Response: The most important take-away message from this study is the results confirm that early integrated palliative care improves a number of key outcomes for patients with incurable cancer. The individuals who received the intervention reported not only higher quality of life over time but also improvements in their mood, ability to cope with the illness, and communication with their doctors about preferences for care at the end of life.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future research efforts should focus whether this model of early integrated palliative care is just as effective for patients with incurable cancers in the broader community as it has been at an academic medical center like the Massachusetts General Hospital. We would want to know if this care model can be helpful for patients and families across diverse cancer care centre settings and clinics. Additionally, we hope to explore the optimal timing and frequency of delivering the palliative care intervention. In our current study, patients assigned to the intervention group began meeting with a palliative care clinician near the time of diagnosis of incurable cancer and then at least monthly thereafter. Perhaps not all patients and their families need this much contact with palliative care, especially as new targeted cancer therapies relieve cancer symptoms and prolong survival. We imagine as the landscape of cancer care continues to evolve, so will the models of delivering palliative care in a patient-centered manner.
MedicalResearch.com: Is there anything else you would like to add?
Response: Finally, in addition to enhancing quality of life, mood, and adaptive coping skills, patients who received palliative care integrated with their oncology care were significantly more like to discuss with their doctors their preferences and wishes for care in the event they were dying, compared to those who received usual oncology care alone. This finding is noteworthy as our palliative care intervention is one of the first to demonstrate a positive impact on communication about end-life-care among patients with advanced cancers.
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2016 Palliative Care in Oncology Symposium ASCO abstract:
Randomized trial of early integrated palliative and oncology care.
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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