Palliative Care Improves Coping in Patients With Incurable Cancers

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Active coping strategies can lead to improvements in quality of life and combat depression.
Active coping strategies can lead to improvements in quality of life and combat depression.
The following article features coverage from the 2017 American Society of Clinical Oncology Annual Meeting in Chicago, Illinois. Click here to read more of Oncology Nurse Advisor's conference coverage. 

CHICAGO — Early integrated palliative care for patients with newly diagnosed incurable cancer increase their use of active coping strategies that lead to improvements in quality of life (QOL) and depression, investigators from Harvard Medical School and Massachusetts General Hospital in Boston reported at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting.

Previous studies by the investigators have demonstrated that early palliative care improves QOL and depression for patients with advanced cancer, but they did not fully understand how palliative care confers these benefits, said Jamie M. Jacobs, PhD. “We do know that palliative care aims to improve patients' ability to cope with physical and emotional side effects by using strategies such as positive reframing and acceptance,” Dr Jacobs said. “Therefore, we set out to examine whether patients receiving early palliative care increased their use of effective and active coping strategies, and whether this improvement explains the positive changes in quality of life and depression that we saw in our previous trial.” She and Joseph Greer, PhD, were co-lead authors of the study, which was led by principal investigator Jennifer S. Temel, MD.

The study enrolled 350 patients who received a new diagnosis of incurable lung or non-colorectal gastrointestinal cancer. They randomly assigned patients to receive early palliative care integrated with oncology care or oncology care alone. Patients completed self-reported measures of quality of life (Functional Assessment of Cancer Therapy-General), depression symptoms (Patient Health Questionnaire-9), and use of active and avoidance coping strategies (Brief Cope) at baseline and at 12 and 24 weeks.

Patients receiving early integrated palliative care reported an increase in their use of active coping strategies from baseline to 24 weeks (B =1.09, SE =0.44; P= .01). Active coping was associated with a significant improvement in QOL (B =1.11, SE =0.28; P =.0001) and depression (B =−0.35, SE =0.09; P =.0003).

A change in active coping mediated the effect of early palliative care intervention on 24-week QOL and 24-week depression after controlling for age, Charlson Comorbidity Index (CCI), baseline QOL and depression, and baseline active coping. These factors accounted for 41% of the variance in QOL and 31% of the variance in depression.

“These findings are particularly notable because they establish a clearer picture of how and why early palliative care may be so beneficial and important for patients with advanced cancer, and highlight the unique role of palliative care in reducing suffering and improving quality of life alongside oncology care,” Dr Jacobs said.

Read more of Oncology Nurse Advisor's coverage of the 2017 American Society of Clinical Oncology Annual Meeting by visiting the conference page.

Reference

1. Jacobs JM, Greer JA, El-Jawahri A, et al. Improved coping mediates the positive effects of integrated palliative care on quality of life and depression. Poster presentation at: 2017 American Society of Clinical Oncology Annual Meeting; June 2-6, 2017; Chicago, IL.


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