Earlier palliative care improves quality of life

Earlier care improves quality of life and patient satisfaction, according to the results of the first clinical study to assess the impact of providing early outpatient palliative care versus standard oncology care in a wide range of advanced cancers.

The 4-year study involved 461 patients at 24 medical oncology clinics at Princess Margaret Cancer Centre, University Health Network (UHN) in Toronto, Canada, with advanced lung, gastrointestinal, genitourinary, breast, and gynecologic cancers.

The findings, published in The Lancet (2014; doi:10.1016/S0140-6736(13)62416-2), demonstrate the benefits of cancer centers providing early specialized palliative care in outpatient clinics, said principal investigator Camilla Zimmermann, MD, of UHN and Princess Margaret.

To put the findings into practice, palliative care teams should be involved much earlier in the course of illness to provide collaborative care together with oncologists, Zimmermann explained.

"The traditional view of palliative care is end-of-life measures, but over the past 10 years specialized palliative care has been evolving into finding ways to improve quality of life earlier on. Our study results can help map the way forward," said Zimmermann. She explained that the key outcome of their study—improved quality of life—occurs when the core intervention of seeing a physician and nurse with specialist palliative care training once a month in the outpatient clinic.

"Another important outcome is that patients reported improved satisfaction of care. We found that patients appreciated having a team of professionals available to provide additional support navigating the cancer system and coping with multiple medical and social issues,” said Zimmermann.

The study, which was a cluster randomized controlled trial with patients with advanced cancer whose prognosis was greater than 6 months, assessed impact using five standard clinical measurement tools to determine quality of life, symptom control, satisfaction with care, and difficulty with medical interactions.

All participants completed a baseline survey and received the same clinical care over 4 months. The 228 patients in the early intervention group also received formal monthly consultation with the palliative care team in a specialized outpatient clinic, plus regular phone follow-up. Initial palliative consultation included a comprehensive, multidisciplinary assessment of symptoms, psychological distress, social support, and home services. When the study ended, patients were offered continued follow-up in the outpatient palliative care clinics.

"Quality of life was an outcome of interest because it is a central focus of palliative care," said Zimmermann. "The research team used a cancer-specific measure encompassing physical, function, social and psychological domains, as well as the spiritual domain, which is of particular relevance in patients with advanced cancer."

Despite the worse status of the intervention group at baseline, the study showed a trend for improved quality of life at 3 months and clinically meaningful improvement at 4 months. Similarly, patient satisfaction with care improved substantially at both 3 and 4 months in the early palliative care group, whereas it deteriorated in the control group.

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