The ASCO provisional clinical opinion on palliative care recently published1 was based largely on data from seven published randomized controlled trials, including a phase III lung cancer trial by Temel and colleagues, which was the trigger for the new recommendations.2 The trial’s principal outcome was quality of life, which was measured by the Functional Assessment of Cancer Therapy–Lung Trial Outcome Index (FACT-LTOI).
The investigators reported that patients assigned to palliative care intervention had measurably higher quality-of-life scores compared with those who received standard care alone. Although the PCO acknowledged certain weaknesses in the study design, the findings demonstrated a marked increase in quality of life for patients with cancer when palliative care services were initated upon a diagnosis of metastatic disease.
PDQ Report
At ASCO’s request, the NCI’s Physician Data Query (PDQ) Supportive and Palliative Care Editorial Board provided a written assessment of the trial by Temel et al. The ASCO Panel is grateful to PDQ for this assessment. The PDQ board concluded that introducing palliative care at time of diagnosis did not result in “a burdensome number of extra visits,” and that the intervention used multiple strategies to care for a heterogeneous population. The report appraised the six additional studies cited by the PCO and commented that the literature in this field is still “in its infancy,” requiring more research and documentation of solutions in diverse cancer populations. The NCI editorial board concluded that it is premature to issue a PCO meant to apply to a general population of patients with cancer.
After reviewing the PDQ report, the ASCO panel responded that although literature review has limitations, the PCO is based on a detailed examination of all available current trial data. The panel emphasized that the majority of trial patients accepted palliative care intervention, and quality-of-life outcomes were positive across all seven trials.
It may be too early in the palliative care initiative to define all the essential components in the concurrent oncology/palliative care model. However, it is important to note that in the Temel et al study of patients with lung cancer, two key principles of palliative care—open communication and medically appropriate goal-setting—had the most influence on treatment choices and patient survival.
Patients who understood their life expectancy and the risk-to-reward estimate of treatments opted for less aggressive end-of-life care but lived longer with better quality of life. As the data indicate, palliative care interventions do no harm to patients. In fact, most trials showed an increase in quality of life and lower use of resources, the ASCO panel concluded.
The provisional clinical opinion is subject to review, as further data become available. ■
References
1. Smith TJ, Temin S, Alesi ER, et al: American Society of Clinical Oncology provisional clinical opinion: The integration of palliative care into standard oncology care. J Clin Oncol. February 6, 2012 (early release online).
2. Temel JS, Greer JA, Muzikansky A, et al: Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733-742, 2010.
See this article in this issue of The ASCO Post for an in-depth interview with Thomas J. Smith, MD, one of the lead authors of the ASCO provisional clinical opinion on palliative care.
