Early palliative care can improve quality of life in advanced cancer40

Early palliative care improved overall health or quality of life (QOL) in patients with advanced cancer after 18 weeks, according to JAMA network opened.

In addition, the researchers found no significant improvements in quality of life at 12 and 24 weeks. The results also showed that more sessions related to early palliative care were associated with increased 2-year survival rates.

“The findings from this study suggest that guidelines for systematic (early palliative care) need to be developed to improve its quality and that different methods of (early palliative care) need to be developed to increase patient adherence,” the study authors write.

Patients assigned to palliative care early, particularly after 18 weeks, experienced strong improvements in overall health and quality of life scores (11.00 points; 95% CI, 0.78–21.22; P = 0.04; effect size = 0.42). After 12 and 24 weeks, patients showed no significant differences in these values.

Over a period of 24 weeks, patients in the intervention group showed a significant improvement in their self-management and coping skills compared to the control group (20.51 points; 95% CI, 12.41–28.61; P

The intervention group had a higher overall survival rate compared to the control group, but the difference between the two groups was not significant. Patients who received 10 or more early palliative care interventions, including care team meetings and telephone coaching sessions, had an increased likelihood of 2-year survival (53.6%; P

“(This) suggests that increasing adherence is an important factor in these interventions,” the study authors wrote.

After 18 weeks, significant differences were observed in factors used to measure quality of life, including loss of appetite (−14.51 points; 95% CI, −27.57 to −1.45; P = 0.03; effect size = −0.42) and constipation (−11.53 points; 95% CI, −23.37 to −0.30; P = .04; effect size = −0.41). After 24 weeks, factors such as physical functioning (12.12 points; 95% CI, 3.31–20.93; P = .007; effect size = 0.54) and fatigue (−7.84 points; 95% CI, −13.52 to −1.08; P = .02; effect size = −0.36) also showed significant changes in scores.

Within the first three weeks, patients enrolled in this study met with the integrated palliative care team to create a plan that included early palliative care and advanced care planning. After approval, palliative care specialists conducted telephone coaching sessions once weekly for the first 12 weeks and then every two weeks until the end of the study. Symptom control and other mental, social, and spiritual issues were assessed every three weeks for 6 months for advanced care planning. Every three weeks, palliative care nurses assessed symptoms using the 12-item scale of the MD Anderson Symptom Inventory and the Patient Health Questionnaire-2.

The study enrolled 144 adults with a mean age of 60.7 years. Patients in the control group (n = 71) received usual oncology care, while patients in the intervention group received early palliative care (n = 73). Of the enrolled patients, 83 were male (57.6%) and 61 were female (42.4%), with almost half of the patients having an educational level below a high school diploma (68 (47.2%)). Of the 144 enrolled participants, 57 (39.6%) were available to complete the 24-week follow-up.

Depending on the hospital, the integrated palliative care teams included palliative care nurses, professionally trained nurse health coaches, and social workers. Nurses with more than 3 years of professional experience were considered health coaches, while nurses who had provided palliative care and received specialized training were considered specialized palliative care nurses. This training included 14 hours of coaching practice through tele-learning and 23 hours of offline lectures.

The primary outcomes of the study included change in global quality of life from baseline to 24 weeks after study entry. Self-assessments were conducted at 12 and 18 weeks. Secondary outcomes included social and existential stress, crisis coping ability, and 2-year survival.

reference

Kang E, Kang JH, Koh SJ, et al. Early integrated palliative care in patients with advanced cancer: a randomized clinical trial. JAMA Netw opened. 2024;7(8):e2426304. Published 2024 Aug 1. doi:10.1001/jamanetworkopen.2024.26304