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Patients with advanced lung cancer not only experienced improved mood and quality of life but also an extension of their lives when palliative care was integrated into their treatment, a new study found.

Conducted by investigators at Massachusetts General Hospital (MGH) in Boston, the study found that patients with meta static non- small cell lung cancer (NSCLC) who received early palliative care along with standard treatment lived more than 2 months longer than patients who received only standard care.1 “We showed that adding the services of a care team focused on quality of life and not altering patients' cancer treatments could both enhance and extend life in patients with an incurable cancer diagnosis,” says lead author Jennifer Temel, MD, of the MGH Cancer Center

A common misconception of palliative care is that it is administered after treatment has failed, but this study demonstrated that it can actually make a difference in survival, notes Dr Temel's MGH colleague and coauthor, Vicki Jackson, MD, MPH. Palliative care teams comprise physicians, nurses, social workers, and chaplains trained to help patients cope with both the psychological and physical challenges associated with serious illness. Although palliative care is usually administered after patients become debilitated, MGH researchers found in a 2007 study that it can be integrated into the treatment of patients newly diagnosed with meta static NSCLC.2

A total of 151 patients in this new, 3-year study were randomly assigned to either standard care or early palliative care integrated with standard treatment The latter group met with the palliative care team within 3 weeks of study enrollment and at least monthly thereafter Patients in the former group were free to access palliative services at any point during the study. All participants completed standard questionnaires on mood and quality of life when they enrolled in the study and again 12 weeks later Responses showed significant improvement in the group receiving palliative care but worsening quality of life in the group receiving standard care. Depression symptoms in the group treated with palliative care were approximately half of those reported in the group receiving standard care at 12 weeks, although the rates of new antidepressant prescriptions were similar in both groups. Greater than half of the patients in the group receiving palliative care had documented resuscitation and end-of-life preferences whereas fewer than 30% in the group treated with standard care had them.

Greater than half of the patients in the standard care group received aggressive end-of-life care (chemotherapy within 14 days of death, when it is usually considered futile) compared with only one-third of the patients in the palliative care group. However patients in the palliative care group lived an average of 11.6 months compared with 8.9 months for patients receiving standard care.

The researchers concluded that in addition to treating the disease, cancer care must focus on managing patients' symptoms and distress related to the diagnosis. They believe the longer survival noted in the patients treated with palliative care was due to improved mood and quality of life, early and more comprehensive management of symptoms and complications, and more appropriate end-of-life care. They plan to launch similar studies in patients with other types of cancers and in other care settings.

Reference

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  • 1
    Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363: 733-742.
  • 2
    Temel JS, Jackson VA, Billings JA, et al. Phase II study: integrated palliative care in newly diagnosed advanced non-small-cell lung cancer patients. J Gin Oncol. 2007; 25: 2371-2382.