A study published in this month’s issue of the New England Journal of Medicine demonstrated the value of early palliative care services in the treatment of patients with advanced lung cancer. A total of 151 patients recently diagnosed with metastatic non-small-cell lung cancer were randomized to either routine cancer care or routine cancer care plus palliative care. Patients assigned to early palliative care met with a member of the palliative care team, which consisted of board-certified palliative care physicians and advanced-practice nurses, within 3 weeks after enrollment and at least monthly thereafter until death. Additional visits with the palliative care service were scheduled at the discretion of the patient, oncologist, or palliative care provider.
General guidelines for the palliative care visits were adapted from the National Consensus Project for Quality Palliative Care and were included in the study protocol. Specific attention was paid to assessing physical and psychosocial symptoms, establishing goals of care, assisting with decision making regarding treatment, and coordinating care on the basis of the individual needs of the patient.
More than half (54%) of patients in the standard care group received aggressive end-of-life care (defined as chemotherapy within 14 days before death, no hospice care, or admission to hospice 3 days or less before death), compared to 33% in the palliative care group (p = 0.05). Despite receiving less aggressive end-of-life care, patients in the palliative care group had significantly longer survival than those in the standard care group (median survival: 11.6 vs. 8.9 months; p = 0.02). Furthermore, patients assigned to early palliative care had significantly higher scores on quality-of-life measures than did those assigned to standard care, and depression was less than half as common in the palliative care group.
While costs of care were not specifically addressed, the study did show that early palliative care for patients with advanced cancer can alter the use of health care services, including care at the end of life. In addition to receiving less aggressive end-of-life care, significantly more patients in the early palliative care had resuscitation preferences documented in their medical record. These results indicate that timely introduction of palliative care may serve to mitigate unnecessary and burdensome personal and societal costs. Future research will be needed to investigate whether palliative care can indeed reduce healthcare expenditures, and whether the early introduction of palliative care can extend survival in other types of cancer and life-limiting illnesses.
Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733-742. The full text is available online at http://www.nejm.org/doi/full/10.1056/NEJMoa1000678.
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