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Another Trial of Outpatient Palliative Care for Patients with Advanced Cancer

February 27, 2014

Another Trial of Outpatient Palliative Care for Patients with Advanced Cancer

  1. Allan S. Brett, MD

Quality of life and patient satisfaction generally were improved with a palliative care intervention.

  1. Allan S. Brett, MD

Does palliative care, offered by specialized teams early in the course of advanced cancer, improve outcomes? To address this question, researchers in Toronto conducted a randomized trial in which 24 cancer clinics at a comprehensive cancer center were assigned to provide either standard care or early palliative care referral (with monthly visits to an outpatient palliative care clinic, telephone support, and other measures). A total of 461 patients (233 control, 228 intervention) with advanced cancer (lung, gastrointestinal, breast, gynecologic, or genitourinary) but good performance status participated in the trial; nearly all patients were receiving chemotherapy, radiation therapy, or both. About 400 patients completed at least one follow-up assessment; about two thirds of intervention patients had at least four palliative care visits.

At 3 months, differences between groups in quality of life according to two standard measures were of borderline statistical significance, favoring the intervention group; at 4 months, differences became highly significant. Patient satisfaction scores also significantly favored the intervention group.

Comment

This study joins two other recent randomized trials (NEJM JW Oncol Hematol Oct 6 2009 and NEJM JW Gen Med Sep 30 2010) that demonstrated improved outcomes in patients with advanced cancer who received palliative care. Whether these benefits will extend beyond the relatively short (4-month) time frame would be useful to know.

Editorialists note the relative scarcity of trained palliative care clinicians and comprehensive outpatient palliative care units. This scarcity raises further questions: What effective elements of palliative care interventions are missing from standard oncology practice? Could some of those elements be incorporated into standard oncology practice? Are most oncology practices simply too busy to spend the requisite time to address patients' concerns that palliative care clinicians address? Are some oncologists uncomfortable addressing both traditional oncology goals (e.g., response to treatment, prolonging survival) and patients' psychological and philosophical concerns simultaneously? Or do patients actually prefer to have two separate teams addressing these somewhat distinct aspects of their medical care?

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (2)

Jeffrey Mendenhall, BSN, RN, CHPN Other Healthcare Professional, Geriatrics, Medical Education Writer

"First, do no harm ..." I began my nursing career in onc/heme at a large teaching hospital in the LA area though I had already learned the transcendent nature of hospice work in nursing school, and planned to do this work after gaining more experience and "high tech" pain and symptom management skills. Palliative care is by its nature holistic; suffering is also holistic. Dying is part of our shared human experience. A very wise oncologist in Glendale CA told me what she tells all her patients with incurable disease: "You will have pain but we will manage it together." Pain and other noxious symptoms often come in advanced disease. Suffering and loss of meaning is unnecessary in attentive, team-based palliative care!

LANCHASAK AKKAYAGORN Other Healthcare Professional, Psychiatry, King Chulalongkorn Memorial Hospital

Integrative Psycho-spiritaul approach is needed in the early stage of disease to make the predictable prognostic patients and their families adjusted to live with the illness as more comfortable minds. Once people begin to allow themselves to see death as the natural process after or even before percieve the disease , they will not afraid of disease too much and they could live as mindful along the treatment. Living good, Dying well.

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