SAN FRANCISCO-Early integration of palliative care in metastatic cancers greatly increases a patient's coping abilities and overall quality of life, and can increase discussions about patient end-of-life care preferences, according to a new study.
In a large cohort of patients with newly diagnosed advanced cancer, early integrated palliative care improved quality of life, mood, communication about end-of-life care preferences, and adaptive coping strategies by 24 weeks, but not at the primary endpoint of 12 weeks.
"Our research looked at a new measure of a patient's ability to cope effectively with their diagnosis. What we found was the patients who received early palliative care were more likely to use adaptive coping strategies-meaning they were more likely to take some action to make their lives better as well as to accept their diagnosis," said lead author Joseph Andrew Greer, PhD, Clinical Director of Psychology and Research Scientist at the Center for Psychiatric Oncology & Behavioral Sciences at Massachusetts General Hospital, Boston. "Palliative care is a key ingredient to improving a quality of life, which is important to both patients and their families."
The results of the study were presented at the ASCO 2016 Palliative Care in Oncology Symposium (Abstract 104).
Integrating Palliative Care
To explore the effects of early palliative care, Greer and colleagues conducted a randomized controlled trial of 350 patients with newly diagnosed incurable lung cancer (non-small cell lung cancer [NSCLC], small cell lung cancer, and mesothelioma) or gastrointestinal cancers (pancreas, hepatobiliary, gastric, and esophageal). The patients received either early palliative care (175 patients) integrated with oncology care, that is, monthly visits with palliative care, or usual oncology care alone (175 patients). The study included 191 lung cancer and 159 GI cancer patients.
Early palliative care has been shown to improve outcomes in patients with newly diagnosed metastatic NSCLC and in patients identified by clinicians as having poor prognosis with advanced cancer. "In patients with advanced cancer and a limited life expectancy, both telephone-based and in-person palliative care interventions improved quality of life, and reduced symptom burden," said Greer. "Additionally, in a sample of 151 patients with newly diagnosed advanced NSCLC, early palliative care integrated in the oncology setting improved quality of life, depression symptoms, illness understanding, and the delivery of end-of-life care."
To determine patient coping abilities, the researchers used the Brief COPE assessment, a measurement tool examining how people respond to stress. This tool examines patient-reported measures, such as acceptance of diagnosis, positive reframing, use of emotional support, and acceptance. The researchers also used the Functional Assessment of Cancer Therapy-General (FACT-G) to assess quality of life and the Patient Health Questionniare-9 (PHQ-9) for mood at baseline.
Trial Results
The results show that, at 24 weeks, patients receiving palliative care were significantly more likely to report using active and engaged coping styles compared to the usual care group. Patients who received early palliative care reported significantly higher quality of life and lower levels of depression at the 24-week mark, but not at 12 weeks.
"Patients assigned to early palliative care had higher quality of life and less depression at 24 weeks, but not at 12 weeks. Also at 24 weeks, the intervention group was significantly more likely to report using active and engaged coping styles compared to the usual care group," said Greer.
In addition, similar proportions of patients at 24 weeks reported that their cancer was unlikely to be cured (33.6% in palliative care and 37.4% in usual care). More than twice as many patients assigned to early palliative care (30.2%) reported that they discussed their end-of-life preferences as compared to the usual care group (14.5%).
Change in quality of life over time differed between the lung and GI cancer cohorts. For lung cancer patients, quality of life improved significantly for the early palliative care group and decreased slightly for the usual care group at 24 weeks. For GI cancers, quality of life was equal for both groups at 12 weeks, but was significantly higher for the early palliative care group than the usual care group at 24 weeks.
"Early palliative care improved quality of life, mood, coping, and the frequency of end-of-life discussions in patients with newly diagnosed lung and GI cancer," Greer noted. "The benefits of the integrated care model extend to other populations with advanced disease and include improved communication about end of life care.
"Future research efforts should focus on the tailoring of palliative care interventions to the illness trajectory and needs of patients with advanced cancer," he concluded.
ASCO recommends concurrent use of palliative care with cancer care early in the course of illness for any patient with metastatic cancer and/or high-symptom burden.
Mark L. Fuerst is a contributing writer.