Benefit of Early Integrated Palliative Care in Patients With Newly Diagnosed Incurable Cancer

Key Points

  • Early integration of palliative care was associated with improved quality of life and reduced depression in patients with newly diagnosed incurable lung or noncolorectal gastrointestinal cancer.
  • Outcomes differed between patients with lung cancer and those with noncolorectal gastrointestinal cancer.

In a study reported in the Journal of Clinical Oncology, Temel et al found that early integration of palliative care resulted in better quality of life and reduced depression in patients with newly diagnosed incurable lung or noncolorectal gastrointestinal cancer. Outcomes differed by cancer type.

Study Details

In the trial, 350 patients were randomized between May 2011 and July 2015 to receive early integrated palliative and oncology care (n = 175; 95 with lung cancer, 80 with gastrointestinal cancer) or usual care (n = 175; 96 with lung cancer, 79 with gastrointestinal cancer). Patients in the intervention group had meetings with a palliative care clinician at least once a month until death; those in the usual-care group met with a palliative care clinician upon request.

The primary endpoint was change in quality of life from baseline to week 12 assessed by the Functional Assessment of Cancer Therapy–General (FACT-G) scale. Secondary endpoints included change in quality of life from baseline to week 24, change in depression on the Patient Health Questionnaire-9 (PHQ-9), and differences in end-of-life communication.

Outcomes

Among all patients, the intervention group had a mean 0.39-point increase in FACT-G scores at 12 weeks vs a 1.13-point decrease in the usual-care group (P = .339); at 24 weeks, changes were a 1.59-point increase vs a 3.40-point decrease from baseline (P = .010). Patients in the intervention group had lower depression scores at week 24 (adjusted mean difference in PHQ-9 = 21.17, P = .048).

Among patients with lung cancer, those in the intervention group had significant improvements in quality of life (P = .024, P = .010) and depression (P = .035 and P = .048) at 12 and 24 weeks compared with the usual-care group. Among patients with gastrointestinal cancers, there were no significant differences in quality of life or depression between groups at week 12 or 24, with both groups showing improvement in quality of life and mood by week 12. Among all patients, those in the intervention group were more likely to discuss wishes with their oncologist if they were dying (30.2% vs 14.5%, P = .004).

The investigators concluded: “For patients with newly diagnosed incurable cancers, early integrated [palliative care] improved [quality of life] and other salient outcomes, with differential effects by cancer type. Early integrated [palliative care] may be most effective if targeted to the specific needs of each patient population.”

The study was supported by grants from the National Institutes of Health and National Institute of Nursing.

Jennifer S. Temel, MD, of Massachusetts General Hospital Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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