Effect of Early Palliative Care on Chemotherapy Use and End-of-Life Care in Patients With Metastatic Non–Small-Cell Lung Cancer

Greer, Joseph A.; Pirl, William F.; Jackson, Vicki A.; Muzikansky, Alona; Lennes, Inga T.; Heist, Rebecca S.; Gallagher, Emily R.; Temel, Jennifer S.

doi:10.1200/jco.2011.35.7996

Cited by 493 publications

(375 citation statements)

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“…A review conducted by the American Society of Clinical Oncology found that, although many studies of palliative care interventions were not comparable because of variation in the services provided, all such interventions provided patients with some improvement in quality of life, symptoms, or satisfaction with care, in the absence of evidence of harm or increased cost 33 . A randomized controlled trial of early palliative care in metastatic lung cancer patients found not only a reduction in chemotherapy use in the last 2 months of life, earlier admission to hospice, and improved quality of life, but also improved survival 34,35 . Furthermore, no difference was observed in the number of lines of chemotherapy provided in the early-palliative-care and standard-care arms, nor any difference in time to progression between the lines of chemotherapy, suggesting that anticancer care and palliative care can be effectively delivered simultaneously 35 .…”

Section: Discussionmentioning

confidence: 99%

“…A randomized controlled trial of early palliative care in metastatic lung cancer patients found not only a reduction in chemotherapy use in the last 2 months of life, earlier admission to hospice, and improved quality of life, but also improved survival 34,35 . Furthermore, no difference was observed in the number of lines of chemotherapy provided in the early-palliative-care and standard-care arms, nor any difference in time to progression between the lines of chemotherapy, suggesting that anticancer care and palliative care can be effectively delivered simultaneously 35 . Providing standard cancer care, including systemic therapy, together with early palliative care appears to provide both quantity and quality of life to patients with advanced disease.…”

Section: Discussionmentioning

confidence: 99%

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Population-Based Trends in Systemic Therapy Use and Cost for Cancer Patients in the Last Year of Life

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Population-Based Trends in Systemic Therapy Use and Cost for Cancer Patients in the Last Year of Life

et al. 2016

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“…Discontinuing EOL chemotherapy is one of the "top five" practices that could reduce medical costs and improve patients' care [11]. Greer et al [12] reported that patients with concurrent palliative and oncologic care ceased intravenous chemotherapy 2 months earlier than did those without palliative care.…”

Section: Introductionmentioning

confidence: 99%

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

Hsu

Chang

et al. 2016

The Oncologist

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Introduction. Although palliative chemotherapy during end‐of‐life care is used for relief of symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive end‐of‐life care and less use of hospice service. This is a population‐based study of the association between palliative chemotherapy and aggressiveness of end‐of‐life care. Patients and Methods. Using the National Health Insurance Research Database of Taiwan, we identified 49,920 patients with metastatic cancer who underwent palliative chemotherapy from January 1, 2009, to December 31, 2011. Patients who received chemotherapy 2–6 months before death were included. Aggressiveness of end‐of‐life care was examined by previously reported indicators. Cardiopulmonary resuscitation and endotracheal tube intubation were included as indicators of aggressive end‐of‐life care. The association between palliative chemotherapy and hospice care was studied. Results. Palliative chemotherapy was associated with more aggressive treatment. After adjustment for patient age, sex, Charlson Comorbidity Index score, cancer group, primary physician's specialty, postdiagnosis survival, hospital characteristics, hospital caseload, urbanization, and geographic regions, more than one emergency room visit (p < .001), more than one intensive care unit admission (p < .001), and endotracheal intubation (p = .02) during end‐of‐life care were significantly more common in patients receiving palliative chemotherapy. Patients who did not receive palliative chemotherapy received more hospice care in the last 6 months of life (p < .001). Conclusion. Although the decision to initiate palliative chemotherapy was made several months before death, this study showed that palliative chemotherapy was associated with more aggressive end‐of‐life care, including more emergency room visits and intensive care unit admissions, and endotracheal intubation. The patients who received palliative chemotherapy received less hospice service toward the end of life. Implications for Practice: Palliative chemotherapy is used for patients with incurable cancer toward the end of life (EOL). Aggressiveness of EOL care and hospice care are related to the quality of life of these patients. This study of data from the Taiwanese National Health Insurance Research Database found that palliative chemotherapy led to more aggressive EOL care and less hospice care. There is a need to provide patients with terminal cancer access to care information that best meets their needs, especially those patients who receive palliative chemotherapy.

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“…1 In contrast, good patientclinician communication can result in patients experiencing better emotional health, improvement in symptoms, increased quality of life, and reduced intensity of treatment at the end of life. [2][3][4][5] Despite the importance of communication, physician and nurse practitioner communication skills training is often conducted using methods, such as lectures, that have not been shown to result in behavior change. In addition, role modeling is infrequent and trainees report that they frequently communicate bad news to patients with little training, supervision, or feedback.…”

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confidence: 99%

Interprofessional Communication Skills Training for Serious Illness: Evaluation of a Small-Group, Simulated Patient Intervention

Bays

Engelberg

Back

et al. 2014

Journal of Palliative Medicine

117

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Background: Communication with patients and families is an essential component of high-quality care in serious illness. Small-group skills training can result in new communication behaviors, but past studies have used facilitators with extensive experience, raising concerns this is not scalable. Objective: The objective was to investigate the effect of an experiential communication skills building workshop (Codetalk), led by newly trained facilitators, on internal medicine trainees' and nurse practitioner students' ability to communicate bad news and express empathy. Design: Trainees participated in Codetalk; skill improvement was evaluated through pre-and post-standardized patient (SP) encounters. Setting and subjects: The subjects were internal medicine residents and nurse practitioner students at two universities. Intervention and measurements: The study was carried out in anywhere from five to eight half-day sessions over a month. The first and last sessions included audiotaped trainee SP encounters coded for effective communication behaviors. The primary outcome was change in communication scores from pre-intervention to postintervention. We also measured trainee characteristics to identify predictors of performance and change in performance over time. Results: We enrolled 145 trainees who completed pre-and post-intervention SP interviews-with participation rates of 52% for physicians and 14% for nurse practitioners. Trainees' scores improved in 8 of 11 coded behaviors ( p < 0.05). The only significant predictors of performance were having participated in the intervention ( p < 0.001) and study site ( p < 0.003). The only predictor of improvement in performance over time was participating in the intervention ( p < 0.001). Conclusions: A communication skills intervention using newly trained facilitators was associated with improvement in trainees' skills in giving bad news and expressing empathy. Improvement in communication skills did not vary by trainee characteristics.

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Effect of Early Palliative Care on Chemotherapy Use and End-of-Life Care in Patients With Metastatic Non–Small-Cell Lung Cancer

Abstract: Although patients with metastatic NSCLC received similar numbers of chemotherapy regimens in the sample, early palliative care optimized the timing of final chemotherapy administration and transition to hospice services, key measures of quality end-of-life care.

Cited by 493 publications

References 30 publications

Population-Based Trends in Systemic Therapy Use and Cost for Cancer Patients in the Last Year of Life

Population-Based Trends in Systemic Therapy Use and Cost for Cancer Patients in the Last Year of Life

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

Interprofessional Communication Skills Training for Serious Illness: Evaluation of a Small-Group, Simulated Patient Intervention

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