Study Confirms Benefits of Early Palliative Care for Advanced Cancer
, by NCI Staff
Patients who received palliative care along with standard treatment for advanced cancer reported having a better quality of life and mood than patients who did not receive early palliative care, according to the results of a randomized clinical trial.
Patients who received early palliative care also scored better on an assessment of their ability to cope with their disease and were more likely to discuss end-of-life care preferences with their health care team.
“We have now shown the benefits of early palliative care for patients with advanced cancer in two clinical trials,” said Joseph A. Greer, Ph.D., of Massachusetts General Hospital, who reported results from the study last month at the American Society of Clinical Oncology Palliative Care in Oncology Symposium in San Francisco.
The other trial, reported by Dr. Greer and his colleagues in 2010, included only patients with advanced lung cancer and reported on the effects of early palliative care on quality of life and mood. For the current study, the researchers enrolled patients with gastrointestinal cancers as well as lung cancers, and they explored new questions, such as the effect of early palliative care on coping skills and end-of-life care discussions.
“This was a well-conducted study that builds on the earlier work of Dr. Greer’s group,” said Diane St. Germain, R.N., M.S., of NCI’s Division of Cancer Prevention. “It is important to determine the impact of early palliative care in additional types of cancer.”
Improving Quality of Life
Palliative care is care that is intended to improve the quality of life of patients who have a serious or life-threatening illness. Most experts define this type of care, which includes managing symptoms, establishing goals of care, and providing psychosocial support, as beginning at diagnosis and continuing throughout a patient’s experience with cancer.
“Palliative care helps individuals stay connected with the activities they care about,” said Dr. Greer. The palliative care team may include physicians, nurses, social workers, and chaplains who have experience helping patients cope with the psychological and spiritual aspects of living with a serious illness.
In the current trial, 350 patients with advanced lung or gastrointestinal cancers—including pancreatic, gastric, and esophageal—were randomly assigned to receive palliative care along with standard treatment or standard treatment alone. Patients in the palliative care group received a visit from a palliative care specialist at least once a month; both groups were evaluated 12 weeks and 24 weeks after their cancer treatment had begun.
Patients with lung cancer who received early palliative care reported improvements in quality of life and mood at 12 and 24 weeks. Among patients with gastrointestinal cancers, however, there was no difference between the two study groups in quality of life or mood at the 12- or 24-week evaluations.
“This finding raises important questions for future research, such as whether palliative care interventions should be tailored by cancer type,” said St. Germain.
The study also showed that 30% of all patients who received early palliative care reported having discussions about their end-of-life care preferences, whereas only 14% of patients receiving standard care alone reported having these discussions.
“What is striking about these results is the low number of patients with incurable, advanced cancer having end-of-life discussions,” said St. Germain, adding that “more work is needed” to understand why the number were low and how these discussions can be encouraged.
At 24 weeks, patients in the palliative care group were more likely to report using what researchers call adaptive-coping strategies than patients in the other group. This style of coping involves taking actions to make one’s life better, such as accepting one’s diagnosis and the use of emotional help.
“A diagnosis of cancer is never easy for patients, so it is promising that we now have a strategy of early palliative care that can help patients cope while improving their quality of life,” commented Andrew S. Epstein, M.D., of Memorial Sloan Kettering Cancer Center, who was not involved in the research, in a news release. “Findings such as these continue to expand and build on the benefits of integrating palliative care into the cancer care continuum.”
As a next step, the researchers have begun to explore the feasibility of implementing an early palliative care approach more broadly. They are evaluating the model at approximately 20 sites around the United States, half of them at academic medical centers and half in community settings.
This work includes a new randomized clinical trial, led by Jennifer S. Temel, M.D., of Massachusetts General Hospital, of early palliative care in patients with incurable lung or gastrointestinal cancers. The trial will try to replicate the findings from the 2010 trial for patients being treated largely at community hospital sites.
“This trial, which is supported by the NCI Community Oncology Research Program (NCORP), will also provide more information on the effect of early palliative care in patients with incurable gastrointestinal cancers,” said St. Germain.
The researchers also intend to study approaches that involve fewer resources than the current strategy. For instance, patients who are relatively healthy at the time of diagnosis might not need as many regular visits from a palliative care specialist as patients whose disease has progressed.
“In this ‘stepped-care’ model,” explained Dr. Greer, “the level of care would match the needs of the patient and would increase as necessary.”