By Matt Silver
SAN FRANCISCO -- September 12, 2016 -- Early palliative care improves the quality of life (QOL), mood, coping, and frequency of end-of-life discussions in patients with newly diagnosed lung cancer or gastrointestinal (GI) cancer, according to a study presented here at the 2016 Palliative Care in Oncology Symposium.
They added that the benefits of the integrated care model extend to other populations with advanced disease and include improved communication about end of life care.
“We were pleased to learn that the early integrated palliative care intervention led to
improvements in how patients cope with their illness,” said lead author Joseph Greer, MD, Massachusetts General Hospital (MGH), Boston, Massachusetts. “For example, compared with patients in the usual 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.”
Dr. Greer and colleagues randomised 350 patients with newly diagnosed incurable lung cancer or GI cancer to palliative care integrated with oncology care (monthly visits with palliative care) or to the usual oncology care.
They used the Functional Assessment of Cancer Therapy-General (FACT-G) to assess QOL and the Patient Health Questionniare-9 (PHQ-9) for mood at baseline and weeks 12 and 24. Chi square tests and linear regression, controlling for baseline values and clinical factors, were used to evaluate intervention effects on patient-reported outcomes.
Patients assigned to early palliative care had higher QOL scores and less depression on the PHQ-9 at 24 weeks, but not at 12 weeks. Also, at 24 weeks, the intervention group was significantly more likely to report using active and engaged coping styles compared with the usual care group.
Although similar proportions of patients at 24 weeks in each group reported that their cancer was unlikely to be cured (33.6% in the palliative care group vs 37.4% in the usual care group), significantly more patients assigned to the palliative care group reported discussing their end-of-life preferences (30.2% vs 14.5%; P = .004).
Change in quality of life over time differed between the lung and GI cancer cohorts. Those with lung cancer saw a decline in quality of life by 12 weeks, which was positively buffered by the intervention with palliative care. However, the group of patients with GI 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 cancer therapy may have reduced symptoms and improved quality of life,” said Dr. Greer.
He added that the next steps for his research are to examine if 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 centre like MGH.
“We would want to know if this care model can be helpful for patients and families across diverse cancer care settings and clinics,” he said. “Additionally, we hope to explore in future research the optimal timing and frequency of delivering the palliative care intervention.”
The 2016 Palliative Care in Oncology Symposium is sponsored by the American Academy of Hospice and Palliative Medicine, the American Society of Clinical Oncology, the American Society for Radiation Oncology, and the Multinational Association of Supportive Care in Cancer.
[Presentation Title: Randomized Trial of Early Integrated Palliative and Oncology Care. Abstract 104]
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