medwireNews: Palliative care should be systematically included in the management of patients with advanced cancer, say Belgian researchers who found early integration is associated with improvement in quality of life (QoL).
Gaëlle Vanbutsele, from Vrije Universiteit Brussel and Ghent University in Brussels, and co-workers questioned whether patients would benefit from the routine addition of palliative care to standard psychosocial care within 12 weeks of a new primary tumour diagnosis or progressive disease.
Overall, 186 patients were recruited to the trial and randomly assigned to receive early and systematic integration of palliative care into standard multidisciplinary care that includes services from medical specialists, psychologists, social workers, dieticians and specialist nurses, or standard care alone.
Although all study participants could access palliative care consultations on demand, patients receiving the intervention were given an appointment with a specialist palliative care nurse within 3 weeks of enrolment and monthly thereafter, and nurses referred patients on for palliative care physician visits where necessary, the team explains.
Over 18 weeks, 89% of the intervention arm had at least one consultation with a palliative care nurse and 27% with a palliative care physician, while by 24 weeks 60% had received at least three palliative care nurse consultations and 35% had visited a physician. The corresponding rates for the controls were 18% and 1% at 18 weeks, and 13% and 1% at 24 weeks.
Patients were followed up for a median of 284 days and overall survival was similar in the intervention and usual care arms, at a median of 312 versus 343 days.
The mean score at 12 weeks for global health status/QoL on the EORTC QLQ C30 measure was significantly higher in the intervention group than the usual care group, at 61.98 versus 54.39, although it did not meet the minimum 10-point threshold for indicating a clinical difference.
The McGill QoL scale – which includes an existential wellbeing dimension – also significantly favoured the integration of early and systematic care at 12 weeks, at scores of 7.05 versus 5.94 with usual care.
And both measures continued to show a significant positive effect on QoL with early integrated palliative care at the 18-week checkpoint, the researchers report in The Lancet Oncology.
“[W]e believe that improved overall quality of life might be related to the differences in the focus of oncology and palliative care”, they write.
“Oncology professionals and psychosocial interventions mostly focus on symptom burden caused by the disease and treatment, whereas palliative care professionals mainly focus on a patient’s quality of life–eg, spending time with family and friends, or partaking in day-to-day activities.”
However, the Norwegian authors of an accompanying comment note that the investigators were unable to determine the specific component of the early, integrated palliative care that led to a QoL benefit and, in common with similar studies, did not detail the tumour-focused care received during the study period.
“What is the optimal content of palliative care? What level of palliative care is needed for a clinically significant difference? What is the optimal way of combining oncological care with palliative care–ie, the optimal level of integration?” ask Stein Kaasa, from Oslo University Hospital, and Jon Håvard Loge, from the University of Oslo.
“These core questions have yet to be answered”, they conclude.
Vanbutsele G, Pardon K, Van Belle S, et al. Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial.Lancet Oncol; Advance online publication 2 February 2018. DOI: https://doi.org/10.1016/S1470-2045(18)30060-3
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