Friday, August 27, 2010

Palliative care

New study shows improved quality of life, extended survival in lung cancer patients

Integrating palliative care early in the treatment of advanced lung cancer not only improved patients' mood and quality of life, but also extended their lives. In the Aug. 19 New England Journal of Medicine (NEJM), MGH investigators reported that patients with metastatic non-small-cell lung cancer (NSCLC) who received early palliative care along with standard treatment lived more than two months longer than those receiving standard care only. Patients with metastatic NSCLC -- the leading cause of cancer death in the United States -- typically are expected to survive less than one year.

"For me as an oncologist, results like this are incredibly exciting," says Jennifer Temel, MD, of the MGH Cancer Center, the paper's lead author. "We showed that adding the services of a care team focused on quality of life could both enhance and extend life in patients with an incurable cancer diagnosis. These findings are very promising, and we are already taking steps to examine the impact of early palliative care in other types of cancer."

Vicki Jackson, MD, MPH, acting chief of the MGH Palliative Care Service and a co-author of the NEJM study, says, "One of the most common misconceptions about palliative care is that it indicates treatment has failed -- that it means giving up. These patients not only lived longer, but they also experienced improved quality of life and were better able to enjoy the time they had remaining."

Palliative care teams consist of physicians, nurses, social workers and chaplains specially trained to help patients deal with the psychological and spiritual aspects of serious illness, as well as managing symptoms such as pain, nausea and shortness of breath. Cancer patients traditionally have been enrolled in palliative care late in the course of their illness, often when they are hospitalized and symptoms have become debilitating. In 2007, the MGH team found that integrating palliative care into the treatment of patients newly diagnosed with metastatic NSCLC was feasible. The current study was designed to evaluate the impact of early, continuing palliative care on patients' lives. 

Study participants -- all recently diagnosed with metastatic NSCLC -- received either standard oncology care or early palliative care integrated with standard care. Participants' responses to standard assessments of mood and quality of life showed significant improvement over the 12-week study period in the palliative care group but worsening quality of life in the standard care group.

"Traditionally, cancer care has focused on treating the disease itself, but now we realize we must also focus on managing patient's symptoms and distress related to their diagnosis," says Temel. "We hypothesize that the increased survival was due to improved mood and quality of life, to early and more comprehensive management of symptoms and complications, and possibly to more appropriate end-of-life care."

Senior author of the NEJM article is Thomas Lynch, MD, former chief of MGH Hematology/Oncology and now director of the Yale Cancer Center. Additional MGH co-authors are Emily Gallagher, RN, MGH Cancer Center; Constance Dahlin, APN, Craig Blinderman, MD, Juliet Jacobsen, MD, and Andrew Billings, MD, Palliative Care; Joseph Greer, PhD, and William Pirl, MD, MPH, Psychiatry; and Alona Muzikansky, Biostatistics.

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