Metastatic non–small-cell lung cancer, the leading cause of death from cancer worldwide, is a debilitating disease that results in a high burden of symptoms and poor quality of life; the estimated prognosis after the diagnosis has been established is less than 1 year.
Due to the high mortality rates of metastatic non-small-cell lung cancer, palliative (e.g., hospice) care offers one option to reduce medical service utilization and improve patient satisfaction. Is palliative care actually able to accomplish these goals?
A study by Temel et al. (2010) attempts to answer this question by randomizing patients with metastatic non–small-cell lung cancer to palliative care. Those randomized to the control group were assigned standard care; these patients were not scheduled to meet with the palliative care service unless a meeting was requested by the patient, the family, or the oncologist.
The results of the study are presented after the jump.
The authors evaluated health-related quality of for the treatment (palliative care) and control (standard care) life using the (FACT-L) scale. FACT-L scale evaluates seven symptoms specific to lung cancer. Patient mood was assessed using the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire 9 (PHQ-9).
The authors measure aggressive treatment of illness using the following outcomes: chemotherapy within 14 days before death, no hospice care, or admission to hospice 3 days or less before death.
Using these outcome measures, the authors found that patients assigned to early palliative care were less likely to receive aggressive treatment and had significantly higher FACT-L scores than the patients in the standard care (control) group. Further, despite receiving less aggressive end-of-life care, patients in the palliative care group had significantly longer survival than those in the standard care group (median survival, 11.6 vs. 8.9 months; P=0.02). The authors conclude that “Early integration of palliative care with standard oncologic care in patients with metastatic non–small-cell lung cancer resulted in survival that was prolonged by approximately 2 months and clinically meaningful improvements in quality of life and mood.”
The findings may indicate that hospice care may not be a replacement of traditional care, but a complimentary service.
Source:
- Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010 Aug 19;363(8):733-42.
This is an important paper for your readership and policy makers.
I would respectfully note – palliative care (the services studied in this paper) is not the same as hospice. The two overlap in end of life care, but palliative care is beneficial for patients in all phases of the continuum of cancer care including those patients with every expectation of curative therapy. Palliative care is also effective in other non cancer diseases such as heart failure and chronic pain.