Can early palliative care with anticancer treatment improve overall survival and patient-related outcomes in advanced lung cancer patients? A review of the literature

Abstract

PurposeMetastatic non-small-cell lung cancer (NSCLC), the leading cause of death from cancer worldwide, is a debilitating disease that results in a high burden of symptoms and poor quality of life; the estimated prognosis after the diagnosis has been established was less than 1 year until some years ago. At the present, the new targeted therapies and immunotherapy are changing the course of the disease. However, advanced NSCLC remains an incurable disease, with a poor prognosis for the majority of the affected patients, so that quality of life and relief from symptoms are primary objectives of treatment. Some evidences suggest that early palliative care (EPC) for these patients can improve quality of life and even survival.DesignA systematic review of the studies evaluating the impact on objective and on patient-reported outcomes of the introduction of EPC in opposition to standard care (SC), for advanced lung cancer patients, was performed. Because of the small number of studies conducted in this area, retrospective studies were also considered for the review.ResultsFive studies were included because they matched the inclusion criteria previously defined as relevant for the study. The review found that both survival and quality of life were better for patients included in EPC groups.ConclusionsWhile results of the studies included in this review are not always comparable because different methods and scales have been used, there is enough evidence for clinical oncologists to implement the use of EPC in clinical practice for advanced lung cancer patients.

Integrating early palliative care into routine practice for patients with cancer: A mixed methods evaluation of the INTEGRATE Project

“…Early palliative care has not yet become a routine part of care for patients with advanced or aggressive cancer despite increasing evidence regarding the benefits . Prior to the introduction of INTEGRATE, the initiation and delivery of palliative care was left to the discretion of providers, resulting in wide variation in practice .…”

“…Early palliative care has not yet become a routine part of care for patients with advanced or aggressive cancer [28][29][30] despite increasing evidence regarding the benefits. 2,3,[6][7][8][9] Prior to the introduction Abbreviations: ACP, Advanced Care Planning; GoC, goals of care. a % responded "yes"; other options: "no" or "not sure."…”

“…Optimally, palliative care should not be limited to the last days and weeks of life, but rather should be provided concurrently with oncology treatment in appropriate patients . Introducing palliative care early in the patient care trajectory for patients with advanced or aggressive illnesses results in improved symptom control, better quality of life, less aggressive care, less distress among family caregivers, and longer survival compared with patients receiving standard care …”

“…With increasing evidence from controlled trials regarding the benefits of the early introduction of palliative care, there is a corresponding need for more studies examining how such interventions are designed, implemented, and sustained in real‐world settings using available resources and structures . Controlled trials limit the generalizability of findings and are rarely designed using an “implementation science” lens with attention to mediating factors such as the organizational context …”

“…1 Introducing palliative care early in the patient care trajectory for patients with advanced or aggressive illnesses results in improved symptom control, better quality of life, less aggressive care, less distress among family caregivers, and longer survival compared with patients receiving standard care. [2][3][4][5][6][7][8][9] With increasing evidence from controlled trials regarding the benefits of the early introduction of palliative care, [2][3][4][5][6][7][8][9] there is a corresponding need for more studies examining how such interventions are designed, implemented, and sustained in real-world settings using available resources and structures. [10][11][12] Controlled trials limit the generalizability of findings and are rarely designed using an "implementation science" lens with attention to mediating factors such as the organizational context.…”