Early Implementation of Palliative Care Can Improve Patient Outcomes

Abstract

Patients with cancer experience many complex issues throughout the trajectory of the disease. These range from the physical consequences of cancer and treatment to the psychological, social, and spiritual issues associated with living with the disease. An individualized, comprehensive, and interdisciplinary approach is needed to reduce patient suffering and ensure appropriate symptom management and support from the time of first diagnosis to end of life. Data from randomized clinical trials prove that patients provided with early palliative care can experience relief of symptoms and improvements in quality of life, mood, satisfaction, resource use, and advanced care planning. Professional organizations such as ASCO have begun to develop recommendations that integrate palliative care into standard oncologic care from the time a person is diagnosed with metastatic or advanced cancer. NCCN has a palliative care guideline that recommends early and ongoing assessment of palliative care needs and referral to specialist palliative care services in more complex cases. In turn, oncologists need to consider how best to screen patients and integrate early palliative care with routine oncologic care, within the context of their busy clinics, to ensure that patients, families, and caregivers receive timely support. (JNCCN 2013;11(Suppl 1): S3-S9)

Early palliative care in cancer treatment: rationale, evidence and clinical implications

“…Patients with advanced cancer often have significant symptom burden, including dyspnea, pain, nausea and fatigue that can cause distress and decreased quality of life (QOL). Care that is aimed at control of symptoms whether from the cancer itself or the toxicity of treatment delivered concurrently with disease-directed therapies, is a key feature of patient-centered care [Glare, 2013;Peppercorn et al 2011]. Early focus on care aimed at improving QOL has been shown to improve patient satisfaction, reduce depression and anxiety, and lead to care more consistent with patient preferences [Higginson and Evans, 2010].…”

Palliative Care Communication

“…A lack of knowledge about palliative care still exists for some providers, 3 making it necessary for palliative care clinicians to provide system-level education about the specialty to establish referral networks. 6 This lack of understanding is convoluted by the debate over the name palliative care, with oncologists reporting palliative care as a distressing term that reduces hope for patients and families. 7 Patient and provider education is needed to help patients and families understand palliative care and the scope of services provided by palliative care teams.…”

Integrating Palliative Care into Active Cancer Treatment

“…4,5,9 There is limited evidence for early integration of palliative care into active cancer treatment; however, results from recent randomized controlled trials (RCTs) support this practice and the science is continuing to evolve. 6 It is important to note that the research findings are often difficult to evaluate because of the lack of standardization of interventions and outcome measures, methodological issues with small sample sizes, and challenges with recruitment and attrition. In addition, research studies as well as clinical practices vary widely in their definition of what constitutes palliative care services and who provides these services.…”

“…Despite new recommendations and guidelines, many oncology providers continue to discuss or consider palliative care very late in the disease trajectory. 6,25 Both the public and healthcare professionals need to understand that early palliative care services, delivered alongside active treatment, improve patient outcomes.…”

“…[3][4][5][6] Recent evidence has demonstrated that palliative care, provided concurrently with disease-modifying treatment early in the course of advanced cancer, can improve QOL, length of survival, symptom burden, mood, and utilization of health services. [3][4][5][6][7][8][9] This evidence has promoted the use of palliative care services at National Cancer Institute (NCI)-designated cancer centers and in non-NCI designated cancer programs. 1,3,9 Much work is needed to increase the availability of these services to all patients with cancer and to dispel the myths that palliative care is something that is reserved for end of life (EOL).…”