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Palliative care intervention for patients with advanced cancer provides quality of life benefits
August 19, 2009CHICAGO - Patients with advanced cancer who received a palliative care intervention focused on addressing physical and psychosocial issues and care coordination that was provided at the same time as cancer treatment reported improved quality of life and mood but did not experience a significant change in the number of days in the hospital or the severity of their symptoms compared to patients who received usual care, according to a study in the August 19 issue of JAMA.
"Fifty percent of persons with cancer are not cured of their disease; however, with improved treatment even patients with advanced disease may live for years. Providing palliative care concurrent with oncology treatment has been proposed to improve quality of life for patients with advanced cancer," the authors write as background information in the article. Although there are recommended guidelines for palliative care concurrent with cancer treatment (such as chemotherapy and radiation), empirical evidence to support this recommendation has been limited.
Marie Bakitas, D.N.Sc., A.P.R.N., of the Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, N.H., and colleagues conducted a study from November 2003 through May 2008 to determine the effect of a palliative care intervention on quality of life, symptom intensity, mood, and resource use in 322 patients with advanced cancer. Patients were randomized to receive either the intervention, a multicomponent, psychoeducational program conducted by advanced practice nurses and consisting of 4 weekly educational sessions and monthly follow-up sessions until death or study completion (n = 161); or usual cancer care (n = 161). The researchers add that the intervention used a case management, educational approach to encourage patient activation, self-management and empowerment.
A number of assessment tools were used to measure quality of life, symptom intensity and mood. These measures were assessed at the beginning of the study, at 1 month and every 3 months until death or study completion.
During the course of the study, there was no statistically significant difference between the groups regarding the number of participants who received parenteral (by injection) chemotherapy or radiation therapy.
The researchers found that the intervention "demonstrated higher quality of life, lower depressed mood, but limited effect on symptom intensity scores and use of resources in intervention participants relative to those receiving usual cancer care. The intervention had no effect on the number of days in the hospital and ICU, the number of emergency department visits, or anticancer treatment because the proportions of participants in each group receiving these therapies were similar."
In regard to symptom intensity, "there may be little room for improvement because usual care participants also reported relatively low symptom intensity scores compared with patients with advanced cancer in other studies," the authors write. "It may be unrealistic to expect to reduce symptoms further in the setting of progressive disease."
"Institute of Medicine reports, the National Consensus Project for Quality Palliative Care, other consensus panels, and oncology professional societies agree that comprehensive cancer care must incorporate more than state-of-the-art disease-modifying treatment. Comprehensive, high-quality cancer care includes interdisciplinary attention to improving physical, psychological, social, spiritual, and existential concerns for the patient and his or her family," the authors write.
Dartmouth-Hitchcock Medical Center
A number of assessment tools were used to measure quality of life, symptom intensity and mood. These measures were assessed at the beginning of the study, at 1 month and every 3 months until death or study completion.
During the course of the study, there was no statistically significant difference between the groups regarding the number of participants who received parenteral (by injection) chemotherapy or radiation therapy.
The researchers found that the intervention "demonstrated higher quality of life, lower depressed mood, but limited effect on symptom intensity scores and use of resources in intervention participants relative to those receiving usual cancer care. The intervention had no effect on the number of days in the hospital and ICU, the number of emergency department visits, or anticancer treatment because the proportions of participants in each group receiving these therapies were similar."
In regard to symptom intensity, "there may be little room for improvement because usual care participants also reported relatively low symptom intensity scores compared with patients with advanced cancer in other studies," the authors write. "It may be unrealistic to expect to reduce symptoms further in the setting of progressive disease."
"Institute of Medicine reports, the National Consensus Project for Quality Palliative Care, other consensus panels, and oncology professional societies agree that comprehensive cancer care must incorporate more than state-of-the-art disease-modifying treatment. Comprehensive, high-quality cancer care includes interdisciplinary attention to improving physical, psychological, social, spiritual, and existential concerns for the patient and his or her family," the authors write.
Dartmouth-Hitchcock Medical Center
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A growing number of older adults are dying from dementia. In an editorial in the October 15, 2009 issue of the New England Journal of Medicine, Greg Sachs, M.D., professor of medicine and director of the Division of General Internal Medicine and Geriatrics at the Indiana University School of Medicine and a Regenstrief Institute investigator, notes that end-of-life care for most older adults with dementia has not changed in decades and urges that these individuals be provided far greater access to palliative care, the management of pain and other symptoms.
Calculate benefit before dialysis for frail elders
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Instanyl sets new standard in management of breakthrough cancer pain
New data presented today further demonstrate the efficacy of Instanyl in management of breakthrough cancer pain. The data which were presented at the 6th congress of the European Federation of Chapters of the International Association for the Study of Pain (EFIC) are from a multinational, crossover trial comparing Instanyl with oral transmucosal fentanyl citrate (OTFC) for the treatment of breakthrough pain in patients with cancer.
Expanded insurance benefits break down barriers to hospice care, according to new study
Patients with advanced illnesses more than doubled their use of hospice care when a major national health plan made hospice care more readily accessible, according to the results of a comparative study published in Journal of Palliative Medicine.
Atrial fibrillation linked to increased hospitalization in heart failure patients
Patients with atrial fibrillation, common in those with advanced chronic heart failure, have an increased risk of hospitalization due to heart failure.
Acupuncture Eases Radiation-Induced Dry Mouth in Cancer Patients
Twice weekly acupuncture treatments relieve debilitating symptoms of xerostomia - severe dry mouth - among patients treated with radiation for head and neck cancer, researchers from The University of Texas M. D. Anderson Cancer Center report in the current online issue of Head & Neck.
Young women warned of lung cancer risks
Seventeen people are still dying from lung cancer each week in Northern Ireland despite a small improvement in survival rates for the disease.
Study finds race and ethnicity affect use of hospice services among patients with advanced cancer
Race and ethnicity appear to have an effect on whether a patient with terminal cancer uses hospice care services, according to a study led by researchers at Beth Israel Deaconess Medical Center (BIDMC).
Brown Expert Offers Guide to End-of-Life Care
Years ago, dying patients in most communities often had a single option if they needed hospice care. Now they have many more; competition reigns.
Surge in older cancer survivors expected as baby boomers age
The United States could be faced with a national health care crisis in the coming decades as the country's baby boomer population ages and a growing number of older adults find themselves diagnosed with and living longer with cancer.
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