August 18, 2010 -- Patients with advanced lung cancer lived longer and with better quality of life when they received early palliative care as opposed to routine care, results of a randomized trial showed.
Early palliative care reduced use of aggressive measures at end of life by more than a third, cut the prevalence of depression in half, and added three months to the median survival of patients with advanced nonsmall-cell lung cancer (NSCLC).
The findings have implications for end-of-life decision making and use of healthcare resources, according to an article in the Aug. 19 issue of the New England Journal of Medicine.
"Although our findings must be replicated in a variety of care settings and cancer populations, the results nonetheless offer great promise for alleviating distress in patients with metastatic disease and addressing critical concerns regarding the use of healthcare services at the end of life," Dr. Jennifer S. Temel of Massachusetts General Hospital in Boston, and her coauthors wrote.
Much of the debate about healthcare reform revolves around quality of care and use of healthcare resources. With its focus on symptom management, psychosocial support, and assistance with decision making, palliative care offers the potential to improve quality of care and reduce use of medical services, the authors wrote in their introduction.
Historically, palliative care has entered patient management late in the disease course to patients who are hospitalized in specialized units or as a consultative service for uncontrolled symptoms, they continued.
Previous studies have suggested that employing palliative care late in a patient's clinical course has no effect on quality or delivery of care.
"To have a meaningful effect on patients' quality of life and end-of- life care, palliative care services must be provided earlier in the course of the disease," the authors noted.
In an effort to assess the impact of early palliative care, investigators conducted a prospective, randomized clinical trial involving 151 patients with metastatic NSCLC. Within eight weeks of diagnosis, the patients were randomized to standard care alone or with integrated palliative care.
General guidelines for palliative care were adapted from the National Consensus Project for Quality Palliative Care. Principal components of palliative care included attention to physical and psychosocial symptoms, establishing goals for care, assisting in decision making regarding treatment, and coordinating care on the basis of individual patient needs.
Patients assigned to palliative care had better quality of life, and only 16 percent of the palliative care group had depressive symptoms versus 38 percent of the control group.
The study also found that fewer patients who received palliative care had aggressive end-of-life care, and patients who received palliative care lived about three months longer.
Dr. Amy S. Kelley and Dr. Diane E. Meier, MD of Mount Sinai School of Medicine in New York wrote an accompanying editorial that said palliative care is "appropriate and potentially beneficial when it is introduced at the time of diagnosis of a serious or life-limiting illness—at the same time as all other appropriate and medical therapies are initiated."
They added that future studies should address the impact of specific components of palliative care to establish evidence to support best practice.
Nonetheless, the results point to the value of a paradigm shift toward earlier implementation of palliative care.
"Perhaps unsurprisingly, reducing patients' misery may help them live longer," Kelley and Meier wrote. "We now have both the means and the knowledge to make palliative care an essential and routine component of evidence-based, high-quality care for the management of serious illness."