CHICAGO, IL—Immediately integrating cancer treatment and palliative care might improve survival at 1 year in patients with advanced cancers, suggest findings from the ENABLE III randomized controlled trial of concurrent palliative cancer care, presented at the 2014 American Society of Clinical Oncology (ASCO) Annual Meeting.
Earlier integration of palliative care with cancer treatment was associated with “a significant survival advantage at 1 year”—but median survival times, quality of life, ER visits, ICU days, and symptom impacts were not statistically different, cautioned lead study author Marie Bakitas, DNSc, APRN, FAAN, of the University of Alabama at Birmingham Comprehensive Cancer Center in Birmingham, Alabama.
“Evidence from randomized controlled trials supports integration of oncology and palliative care (but) how soon after diagnosis to initiate palliative care has not been identified,” Bakitas noted.
To answer that question, the researchers enrolled patients with advanced cancer who were undergoing treatment at cancer centers and community clinics in New Hampshire and Vermont, to compare immediate vs. delayed initiation of concurrent oncology and palliative care.
A total of 207 study participants were randomized to receive immediate integration of cancer treatment and palliative care (n=104), or to undergo cancer treatment for 3 months prior to integration with palliative care (“delayed” group; n=103).
“Compared to delayed entry patients, the risk of death was lower for immediate participants at 1 year” (hazard ratio [HR] 0.72; 95% CI: 0.57-0.89; P = .003), Bakitas and coauthors reported. “Median survival for immediate entry patients was 18.3 months (95% CI: 13.2-28.0) and 11.9 months for delayed entry patients” (P = .17, not significant).
“A 3-month delay is still very early,” noted Bakitas. On average, hospice care does not begin until 19 days before a patient dies, she noted.
It is not clear why patients who received earlier integration of palliative care, appeared to survive longer than those for whom palliation was delayed.
“At this time we do not have the data to support specific mechanisms,” Bakitas said. “Future research is needed to define mechanisms of survival advantage in palliative care trials.”
“This is not the first study to show a difference in survival,” commented Jennifer Temel, MD, of the Massachusetts General Hospital in Boston, Massachusetts, who authored a smaller but similar study. “But patient-reported outcomes [in this study] didn’t support the hypothesis that this is due to a slightly healthier population of patients.”
The new study included patients with different kinds of cancer, Temel noted. “With mixed cancer populations, there will be different symptoms burdens,” which might have obscured clues that could shed light on why earlier palliation might correlate with longer survival.
“Our primary [research] goal needs to be to find the mechanisms that led to improved survival,” she said.
Clinical trial information: NCT01245621