Although palliative care is a recognized therapeutic intervention that can improve patients’ quality of life, the lines between palliative care and hospice can be blurred in the eyes of patients and family. Current recommendations are that palliative care is most effective when initiated early in the course of treatment. However, even though hospice comes at a later stage of illness, both modalities are subject to confusion and stigma resulting from patients’ misconceptions.
Early palliative care improves the life expectancy, mental outlook, and psychological and physical health of patients with cancer. And yet, through a series of interviews designed to assess patient and caregiver perceptions of palliative care, a group of physicians in Canada found that palliative care was often associated with loss of hope, end-of-life care, even death.1
For this 4-month randomized, controlled trial, conducted at Princess Margaret Cancer Centre in Toronto, Canada, researchers enrolled 48 patients, randomized to an intervention group (n = 26) or a control group (n = 22). To qualify for the study, patients had to have a diagnosis of advanced cancer and an estimated survival expectancy of 6 to 24 months. Researchers also enrolled 23 caregivers, randomizing them to the 2 groups (14 to the intervention group, 9 to the control group). Patients ranged in age from 57 years to 65 years. Involved cancer sites were lung, gastrointestinal, genitourinary, breast, and gynecologic.
The intervention group received standard oncology care plus an early referral for palliative care, which included a consultation and at least a monthly follow-up at an outpatient oncology palliative care clinic for the duration of the study. The control group received standard oncology care only; however, they received palliative care if they requested it. Twenty-two patients in the intervention group and 20 in the control group underwent chemotherapy.