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Association of Early Palliative Care With Patient-Reported Outcomes and End-of-Life Care

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Key Points

  • Patients with a higher proportion of PC visits addressing coping had improvement in depression symptoms and QOL.
  • Patients with a higher proportion of visits addressing advance care planning were more likely to use hospice.  

In a study reported in the Journal of Clinical Oncology, Hoerger et al found that patients with a higher proportion of early palliative care visits addressing behavioral coping strategies had improvement in depression symptoms and quality of life. In addition, those with a high proportion of visits focusing on advance care planning were more likely to use hospice.

Study Details

The study involved 171 patients with newly diagnosed advanced lung or noncolorectal gastrointestinal cancers who had been randomly assigned to receive early palliative care between May 2011 and July  2015 at Massachusetts General Hospital. Patients attended at least monthly visits with board-certified palliative care physicians and advanced practice nurses.

Palliative care clinicians completed surveys documenting the content of each visit. Patients reported quality of life (QOL) on the Functional Assessment of Cancer Therapy–General scale and mood on the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire (PHQ)-9 at baseline and 24 weeks. Data on end-of-life care were obtained from electronic health records.

Visit Content and Outcomes

Of 2,921 palliative care visits, most addressed coping (64.2%) and symptom management (74.5%). By 24 weeks, patients who had a higher proportion of visits addressing coping had improved quality of life (P = .02) and depression symptoms (P = .002 on HADS; P = .004 on PHQ-9) vs baseline. Patients with a higher proportion of visits focusing on symptom management had worsened QOL (P = .02) and worsened symptoms of depression (P = .01 on PHQ-9) and anxiety (P = .03 on HADS anxiety subscale) from baseline to week 24.

Patients with a higher proportion of visits addressing treatment decisions were less likely to initiate chemotherapy (P = .02) or be hospitalized (P = .005) in the 60 days before death. Patients with a higher proportion of visits addressing advance care planning were more likely to use hospice (P = .03).

The investigators concluded, “[Palliative care] clinicians’ focus on coping, treatment decisions, and advance care planning is associated with improved patient outcomes. These data define the key elements of early [palliative care] to enable dissemination of the integrated care model.”

The study was supported by the National Institute of Nursing Research and National Institute of General Medical Sciences.

Michael Hoerger, PhD, of Tulane Cancer Center, is the corresponding author for 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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