Palliative Care for Patients with Advanced Cancer
Improves Quality of Life and Mood
Not much change in days they spent in the hospital
or the severity of their symptoms
Aug. 18, 2009 One of the reasons the provision to
pay doctors to provide end-of-life counseling was added to the health
care reform bill, was to be sure Medicare patients were aware of the
availability of palliative and hospice care. A new study confirms that
at least for patients with advanced cancer, such care focused on
physical and psychosocial issues and care coordination improved quality
of life and mood, even though there was not much change in days they
spent in the hospital or the severity of their symptoms.
The care was provided at the same time as the
cancer treatment, according to a report on the study in the August 19
issue of the Journal of the American Medical Association.
"Fifty percent of persons with cancer are not cured
of their disease; however, with improved treatment even patients with
advanced disease may live for years. Providing palliative care
concurrent with oncology treatment has been proposed to improve quality
of life for patients with advanced cancer," the authors write as
background information the motivated their study.
Although there are recommended guidelines for
palliative care concurrent with cancer treatment (such as chemotherapy
and radiation), empirical evidence to support this recommendation has
been limited.
Marie Bakitas, D.N.Sc., A.P.R.N., of the Norris
Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, N.H.,
and colleagues conducted a study from November 2003 through May 2008 to
determine the effect of a palliative care intervention on quality of
life, symptom intensity, mood, and resource use in 322 patients with
advanced cancer.
Patients were randomized to receive either the
intervention, a multicomponent, psychoeducational program conducted by
advanced practice nurses and consisting of 4 weekly educational sessions
and monthly follow-up sessions until death or study completion (161
patients); or usual cancer care (161 patients).
The researchers add that the intervention used a
case management, educational approach to encourage patient activation,
self-management and empowerment.
A number of assessment tools were used to measure
quality of life, symptom intensity and mood. These measures were
assessed at the beginning of the study, at 1 month and every 3 months
until death or study completion.
During the course of the study, there was no
statistically significant difference between the groups regarding the
number of participants who received parenteral (by injection)
chemotherapy or radiation therapy.
The researchers found that the intervention
"demonstrated higher quality of life, lower depressed mood, but limited
effect on symptom intensity scores and use of resources in intervention
participants relative to those receiving usual cancer care.
The intervention had no effect on the number of
days in the hospital and ICU, the number of emergency department visits,
or anticancer treatment because the proportions of participants in each
group receiving these therapies were similar."
In regard to symptom intensity, "there may be
little room for improvement because usual care participants also
reported relatively low symptom intensity scores compared with patients
with advanced cancer in other studies," the authors write.
"It may be unrealistic to expect to reduce symptoms
further in the setting of progressive disease."
"Institute of Medicine reports, the National
Consensus Project for Quality Palliative Care, other consensus panels,
and oncology professional societies agree that comprehensive cancer care
must incorporate more than state-of-the-art disease-modifying treatment.
Comprehensive, high-quality cancer care includes
interdisciplinary attention to improving physical, psychological,
social, spiritual, and existential concerns for the patient and his or
her family," the authors write.
This study was supported by a National Cancer
Institute grant.
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Aug. 18, 2009 One of the reasons the provision to
pay doctors to provide end-of-life counseling was added to the health
care reform bill, was to be sure Medicare patients were aware of the
availability of palliative and hospice care. A new study confirms that
at least for patients with advanced cancer, such care focused on
physical and psychosocial issues and care coordination improved quality
of life and mood, even though there was not much change in days they
spent in the hospital or the severity of their symptoms.
