Study Also Shows Palliative Care Improves Quality of Life for Advanced Lung Cancer Patients
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Reviewed By Laura J. Martin, MD
Aug. 18, 2010 -- Offering palliative care, including pain management and counseling services, soon after diagnosis can help people with advanced lung cancer live longer and with a better quality of life, a study shows.
The study is published in the Aug. 19 issue of the New England Journal of Medicine.
Palliative care involves a team of doctors, nurses, social workers, and chaplains who help individuals and their families cope with pain and symptoms as well as the emotional and spiritual aspects of their diagnosis.
In the new three-year study, people diagnosed with spreading non-small-cell lung cancer who received palliative care early on, along with cancer treatments, showed marked improvement in their overall quality of life and lived more than two months longer than those who received cancer treatment without palliative services.
People in the palliative care group were 50% less likely to have symptoms of clinical depression, although the rate at which new antidepressant prescriptions were written was similar among both groups. The new study also showed that people who received the palliative support services were less likely to choose aggressive, and often futile, measures to prolong their lives.
"We were surprised by the magnitude of impact that palliative care had on quality of life, which normally decreases over time in these cancer patients, and the magnitude of the impact it had on depression," says Jennifer S. Temel, MD, an oncologist at Massachusetts General Hospital (MGH) Cancer Center in Boston. "The survival benefit was the most surprising thing."
"Cancer care and palliative care are not mutually exclusive. Providing both is not only feasible, but beneficial," she says.
Study participants met with their palliative care team within three weeks of the study's inception, and then at least once a month going forward. Participants who were not in the palliative care group were permitted to access the services at any point.
Temel worked closely with Vicki Jackson, MD, MPH, acting chief of the MGH Palliative Care Service to conduct the study.
Palliative Care May Benefit Other Diseases
The new findings may apply to other serious diseases, Jackson says.
"We don't have data to support it yet, but we hope that palliative care can improve outcomes for a variety of other diseases," she says.
Fully 75% of larger hospitals in the U.S. offer palliative care services, Jackson says. "Ask providers about the availability of palliative care to help navigate your illness," she suggests. Palliative care is different than hospice care in that it is offered regardless of a person's diagnosis or illness prognosis. Palliative care can be offered in the hospital or in the clinic on an outpatient basis.
"These services are vital to the treatment of every patient with cancer because cancer symptoms cause both physical and psychological discomfort," says Mark Kris, MD, chief of thoracic oncology at Memorial Sloan-Kettering Cancer Center in New York City. "This paper says that by dealing with these symptoms, people live better and longer."
This survival edge makes sense to Kris. "If people felt better in general, they are better able to tolerate their treatments and receive the full doses on time or are fit enough to try another treatment," he tells WebMD. All of these things can improve survival.
"When people feel better, they make better choices and palliative care helps them make better decisions about what is helpful and what is fruitless," he says, referring to the study finding that people who received palliative care were less likely to opt for aggressive end-of-life care.
Lack of Access to Palliative Care
Unfortunately this type of supportive care is not always available across the board, he says.
"Not every center has the luxury," Kris says. "It involves additional visits on additional days -- in additional parts of the hospital -- and there are financial aspects, too," he says.
"This is a landmark trial establishing what one might readily have guessed, which is that palliative care can improve symptoms and quality of life," says oncologist and board-certified palliative care specialist Michael J. Fisch, MD, MPH, chair of the department of general oncology in the division of cancer medicine at the University of Texas M.D. Anderson Cancer Center in Houston.
The survival advantage was surprising, but "comprehensive interdisciplinary care with a focus on patients and family builds synergism and positive momentum and that could extend toward improving survival," he says.
Palliative care "can make a difference. It's not just a nice thing to do that maybe adds to the cost of care, but it is probably the way forward for good health outcomes," he says. "These individuals lived longer and felt better and used resources more appropriately. That is quite a combination."
The next step is to figure out where these findings can be applied to other diseases, other institutions, and other patient populations, he says. "How do we make this roll out?"
David Debono, MD, a senior staff physician in palliative medicine at Henry Ford Hospital in Detroit, says cancer treatment and palliative care can -- and should -- go hand in hand. The new findings are "exciting" and "validate what many of us are doing and seeing," he says.
SOURCES: Temel, J.S. New England Journal of Medicine, 2010; vol 363: pp 733-742.
Jennifer S. Temel, MD, oncologist, Massachusetts General Hospital Cancer Center, Boston.
Vicki Jackson, MD, MPH, acting chief, Palliative Care Service, Massachusetts General Hospital Cancer Center, Boston.
Mark Kris, MD, chief, thoracic oncology, Memorial Sloan-Kettering Cancer Center, New York City.
Michael J. Fisch, MD, MPH, chair, general oncology, division of cancer medicine, University of Texas M.D. Anderson Cancer Center, Houston.
David Debono, MD, senior staff physician, palliative medicine, Henry Ford Hospital, Detroit.
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