Early palliative care may extend lung cancer survival
Friday 20 August 2010
Writing in the New England Journal of Medicine, a research team at Massachusetts General Hospital (MGH) in the US found that patients with advanced non-small-cell lung cancer that had spread to other parts of their body typically lived for more than two months longer than expected if they received earlier palliative care alongside their usual treatment.
On average, patients with metastatic NSCLC survive for less than one year after their cancer starts to spread.
Lead author Dr Jennifer Temel, assistant professor of medicine at the MGH Cancer Centre, described the findings in the New England Journal of Medicine as "incredibly exciting".
She revealed: "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.
"These findings are very promising, and we are already taking steps to examine the impact of early palliative care in other situations."
The team's study looked at the impact of early, continuing palliative care - involving doctors, nurses, social workers and chaplains who help patients to deal with the psychological and spiritual aspects of their disease as well as their physical side-effects - on patients' lives.
Of the 151 patients who took part in the study, 74 were given standard care while the remaining 77 received early palliative care alongside their cancer treatment.
After 12 weeks, responses to quality-of-life questionnaires showed that members of the palliative care group had experienced improvements, while those in the standard care group reported a worsening in their quality of life.
Depressive symptoms were about twice as common in the standard care group.
The research also found that fewer patients in the palliative care group opted to receive aggressive end-of-life care - in which chemotherapy is given at a time when it is unlikely to be of benefit.
Yet patients in the palliative care group typically lived for 11.6 months, while those in the standard care group lived for less than nine months, on average.
Dr Temel said that the study shows the importance of managing patients' symptoms and distress, as well as the disease itself.
"We hypothesise that the increased survival was due to improved mood and quality of life, to early and more comprehensive management of symptoms and complications, and possibly to more appropriate end-of-life care," she revealed.
"Similar studies in patients with other types of cancers and in other care settings will help us better understand the impact palliative care can have on the wellbeing and health of all patients with cancer."
Co-author Dr Vicki Jackson, acting chief of the MGH Palliative Care Service, said that palliative care is often wrongly regarded as a sign of "giving up".
"In this study the addition of palliative care early in the course of illness extended the survival of patients with incurable lung cancer," she noted.
"These patients not only lived longer, they also experienced improved quality of life and were better able to enjoy the time they had remaining."
Jean Slocombe, Cancer Research UK's senior cancer information nurse, said: "This is an interesting study as it demonstrates that there are real benefits to patients in receiving palliative care. The UK has excellent and well-established palliative care services and this research helps validate the outstanding work that these teams do."
Jennifer S. Temel, et al (2010). Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer N Engl J Med (363), 733-742
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