Early use of palliative care in cancer improves patients' lives and outcomes for caregivers

A new randomized clinical trial has noted significant improvement in several measures among those who began palliative care early. The findings from the ENABLE III trial were published recently in the Journal of Clinical Oncology (2015; doi:10.1200/JCO.2014.58.6362).

"Survivorship and quality of life are of great interest in clinical cancer research, but can be difficult to evaluate because of high mortality and the need to measure patient-reported outcomes," explained Tor Tosteson, ScD, a biostatistician at Dartmouth's Norris Cotton Cancer Center (NCCC) in Hanover, New Hampshire.

"We developed trial designs and analytic methods that allow the joint estimation and comparison of survival and quality of life data between different treatment strategies. The ENABLE trials have helped to establish the beneficial effects of palliative care on overall survival by interventions targeting patient outcomes."

The team's previous ENABLE II trial established that a carefully designed intervention for patients with late-stage cancers improved both quality of life and survival. The recently published ENABLE III study found that an earlier intervention strategy improved survival further.

In this study, investigators researched the outcomes of palliative care that began at the first visit or 3 months later among 207 patients with late-stage cancer. Though the early entry participants' patient-reported outcomes were not statistically different from the late-entry participants', their 1-year survival after enrollment was improved at 63% versus 48% for those who entered later, a 15% improvement. Additionally, outcomes for caregivers were improved.

"Early interventions for caregivers lowered their depression and stress burden in the last month of the patient's life," reported Kathleen Lyons, ScD, also of Dartmouth.

Looking forward, analyses are underway to identify the mediating factors leading to improved survival and quality of life in both patients and caregivers.

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