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Palliative Care for Cancer Patients

Interventions improved quality of life and mood.

Optimizing quality of life (QOL) for patients and their families is a primary goal of palliative care. Indeed, clinical practice guidelines for palliative care focus on QOL issues, including alleviation of suffering, assistance with medical decision making, and bereavement counseling. However, data demonstrating positive effects from implementing such guidelines are scarce.

To assess the effects of palliative care in oncology treatment, investigators studied 322 newly diagnosed patients with advanced cancer who were randomized to usual care alone or with palliative care intervention derived from Project ENABLE (Educate, Nurture, Advise, Before Life Ends), which incorporates core elements from national palliative care guidelines. Palliative care patients received instruction and support from specially trained nurses during four weekly sessions via telephone and then monthly follow-up sessions until death or study completion. Although the usual-care group did not receive this active intervention, they could make use of all oncology and supportive services, including referral to an interdisciplinary palliative care team.

Palliative care patients had higher QOL scores and were less likely to be depressed than those who received usual care only (P=0.02 for both endpoints). No significant between-group differences were observed in symptom intensity, survival, or use of medical resources (number of days spent in the hospital or intensive care unit, emergency department visits, or anticancer treatments).

Comment: This study is among the first group of randomized controlled trials to test a palliative care intervention given in tandem with oncology treatment. Improvements in QOL and mood conferred by palliative care interventions not only were statistically significant but also were probably clinically meaningful, given the magnitude of change in these measures (>1 standard error difference between groups). These improvements might be explained by better social support, patient self-advocacy, and coordination of care resulting from the intervention. The finding that resource utilization did not differ between groups could have resulted from data collecting via chart review as opposed to analysis of a more comprehensive database. Symptom relief is a tenet of palliative care, but data from most studies have not shown that palliative care lessens symptom intensity. In this study, the intervention's lack of effect on symptom intensity might be attributed to the relatively low intensity scores at baseline and to the use of telephone-based, rather than face-to-face, contact.

— William J. Gradishar, MD

Published in Journal Watch Oncology and Hematology October 6, 2009

Citation(s):

Bakitas M et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. JAMA 2009 Aug 19; 302:741.

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