Palliative Care Benefits Not Restricted to End of Life

Early referral to a palliative care team may improve the experience of patients with advanced cancer

  • Date: 20 Feb 2014
  • Author: Lynda Williams, Senior medwireNews Reporter
  • Topic: Palliative Care

medwireNews: Patients with advanced cancer may experience better quality of life (QoL) if they are given palliative care at an earlier stage of disease than would usually be offered, Canadian research suggests.

The cluster randomised controlled trial, published in The Lancet, examined the impact of early referral to palliative care for patients attending 24 clinics with advanced lung, gastrointestinal, genitourinary, gynaecological or breast tumours, a performance status of 0 to 2 and a survival prognosis of 6 to 24 months.

Outpatient and inpatient oncology palliative care teams provided comprehensive multidisciplinary services to assess symptoms, distress, social support and home services within a month of referral, followed up by regular palliative nurse calls and emergency telephone support.

The study did not achieve the primary outcome of a significantly greater improvement in the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT-Sp) scores for 228 patients after 3 months of integrated palliative and oncology care compared with the 223 patients who, in line with usual care, had not been offered palliative care.

However, receipt of early palliative care was associated with significant gains on the Quality of Life at the End of Life (QUAL-E) assessment at the 3-month checkpoint, as well as improvements on the FAMCARE-P 16 score for patient satisfaction of care, report Camilla Zimmermann, from the University of Toronto in Ontario, and co-authors.

And by the 4-month checkpoint, early palliative care was associated with significant gains on all three assessments, in addition to the Edmonton Symptom Assessment System for symptom severity.

Early palliative care did not significantly influence problems with medical interactions, as measured using the Cancer Rehabilitation Evaluation System Medical Interaction Subscale, at either time point.

“These results provide support for earlier involvement of palliative care teams for patients with advanced cancer,” the researchers conclude.

“Further studies are needed to establish which patients are most likely to benefit; a cost analysis is underway, and will establish the economic implications of implementing this model.”

Writing in an accompanying comment, Susan Block and J Andrew Billings, from Harvard Medical School in Boston, Massachusetts, USA, note that 64% of the palliative care patients had at least four palliative outpatient visits over 4 months of follow-up and 17% were admitted to a specialist nursing home.

They question whether such an intensive intervention is likely to be feasible for all cancer patients when there is a shortage of palliative care physicians and therefore suggest that oncologists and other specialists could benefit from palliative care training, such as in the use of clinical aids for identifying a patient’s palliative needs.

“Moving forward, health-care professionals are challenged to build on the study by Zimmermann and colleagues, deconstructing what worked in a model of intensive specialised outpatient care that is feasible for small numbers of patients, and then integrating these best practices into new systems aimed at serving the many patients who could benefit from outpatient palliative care,” the commentators write.

References

Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet ; Advance online publication 19 February 2014. doi:10.1016/S0140-6736(13)62416-2

Block S and Billings J. A need for scalable outpatient palliative care interventions. Lancet ; Advance online publication 19 February 2014. doi:10.1016/S0140-6736(13)62676-8

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