An important new study finds that patients with metastatic lung cancer who received early palliative care both lived longer and reported a better quality of life than similar patients who had only standard cancer treatment.
Palliative care focuses on treating symptoms, although, unlike hospice, patients may still receive treatment for their terminal disease if they wish. Palliative care also coordinates care, provides social and spiritual assistance, and helps the patient make treatment choices.
The study, published by The New England Journal of Medicine, was done at Massachusetts General Hospital. Unlike other palliative care studies, it was base on a formal randomized trial. Some of the findings were remarkable.
While the palliative care patients often chose less aggresive treatment, they lived almost three months longer than those receiving only standard cancer care. They spent less time in the hospital, enrolled earlier in hospice, and were more likely to inform their physicians of their end of life wishes. In addition, they were less depressed and reported a significantly higher quality of life.
The authors conclude that a key to the success of the program was early enrollment. Patients began receiving palliative care within eight weeks of diagnosis.
While this study provides important evidence of the value of palliative care, it does not mean that all patients everywhere will do as well. The Mass General program is well designed with teams of both lung cancer and palliative care specialists. The study participants were well informed of what the program was and what their care would be like.
Patients in other settings may not have these advantages. One physician who cares for many terminal ill patients told me that many drop out of palliative care programs because medical professionals never take the time to fully explain how the program works. Some patients fear they are being written off and will receive less attention while in the program.
The study did not attempt to distinguish which elements of the Mass General palliative care program was most beneficial. I suspect, however, that its ability to manage pain was a key factor in both better mood and longer life expectancy.
Still, this study is powerful evidence that palliative care works, especially if made available early. More hospitals and skilled nursing facilities would do their patients a great service by adopting this model. And patients with serious illnesses should begin seeking out providers who do.
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