Integrating Palliative Care Early in Cancer Diagnosis Improves Quality of Life, May Improve Outcomes

Although patients and health care professionals frequently and incorrectly equate palliative care with end-of-life care, 2 important studies have reinforced that earlier integration of palliative care in cancer treatment can improve patients’ quality of life and could potentially extend survival.

In a session Thursday at the Community Oncology Alliance virtual 2021 conference, presenter Morvarid Razaie, DO, HMDC, FACOI, said palliative care is an approach that improves quality of life for patients and their families who are facing a life-threatening and potentially life-limiting illness. The approach focuses on alleviating suffering and managing symptoms, including physical symptoms, mental health, and difficult decisions that can come with cancer diagnoses.

“Palliative care unfortunately gets incorporated late in patients’ care whenever it comes to late-stage cancer,” Razaie said. “We really need to try to incorporate it earlier on.”

Guidelines for palliative care include patients’ understanding and education around their illness, symptom management, decision-making about their treatments, and coping with their diagnosis. These interventions can also involve family members and caretakers, Razaie said, noting that the ENABLE II study encouraged participants to choose a family member to take part in the interventions.

Razaie reviewed 2 studies of palliative care and its impact on patients with cancer, both of which found promising results. The first, a study with findings published in the New England Journal of Medicine (NEJM), investigated early integration of palliative care in patients with advanced stage non-small cell lung cancer (NSCLC).

Investigators studied earlier palliative care integrated with standard oncologic treatments compared to standard oncologic care alone. Patients in the palliative care group had at least monthly contact with a palliative care provider until their death, although Razaie noted that patients in the control group could receive palliative care services if they requested them.

The study enrolled 151 patients and found no significant difference between the groups at baseline for quality of life and mood. According to the study findings, patients who received earlier palliative care had higher scores on the Functional Assessment of Cancer Therapy – Lung (FACT-L) scale, the FACT-Lung Cancer Subscale, (FACT-LCS), and Trial Outcome Index (TOI). Researchers also noted a lower percentage of patients with depression, improved quality of life, and, significantly, longer survival.

Razaie noted that the percentage of patients with a first-time antidepressant prescription was similar between both the intervention group and the control group, and the median duration of follow-up for patients who died was 5.7 months. Furthermore, more patients in the standard-of-care group received aggressive end-of-life care, such as chemotherapy or resuscitation efforts. Fewer patients in the control group had addressed their resuscitation preferences, which Razaie said is essential for patients with life-threatening diagnoses.

Next, Razaie discussed the ENABLE II study, which compared palliative care interventions to usual care for patients newly diagnosed with cancer. Unlike the NEJM study, the ENABLE II study did not limit participants to those with NSCLC. The primary endpoints were quality of life, symptom intensity, and mood.

According to Razaie’s presentation, the intervention arm included case management, encouraged patient participation and empowerment, a distress thermometer to measure patients’ distress levels, and monthly shared medical appointments. The usual care arm received normal standards of care and were allowed to use all oncologic and support services without restrictions.

Interestingly, Razaie said this study found similar results in quality-of-life scores but no statistically significant medical differences. For example, there were no significant differences in the number of days spent in the hospital or intensive care unit, and no difference in the number of emergency department visits. There was also no statistically significant difference in survival and a limited impact on symptom intensity. However, the investigators noted higher quality of life scores, lower depression scores, and lower depressed moods.

When considering how to implement palliative care into an oncology practice, Razaie said it is important to consider the wide-ranging needs of patients. With a dedicated team to address the complex physical, emotional, psychosocial, and spiritual needs of this patient population, Razaie said incorporating a palliative care practice can actually relieve time for oncology teams, allowing them to focus more on the necessary treatments.

Accessibility and access to palliative care is also a challenge, Razaie said, although availability has grown approximately 150% over the past decade. Expansion first requires a robust referral base however, so she said spreading awareness among physicians should be a priority, both through building partnerships and including palliative care in medical school curriculums and trainings.

REFERENCE

Rezaie M. Integrating Palliative Care Into Community Practice; April 8, 2021. Presented at: Community Oncology Alliance virtual 2021 conference. Accessed April 8, 2021.