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04-01-2012 | General practice | Article

Early palliative care optimizes treatment and end-of-life care for lung cancer patients


Free abstract

MedWire News: Providing early palliative care improves the timing of final chemotherapy and quality of hospice care for lung cancer patients at the end of their lives, shows research.

This study, published in the Journal of Clinical Oncology, looked at the frequency and timing of chemotherapy and transition to hospice care in patients with metastatic non-small-cell lung cancer (NSCLC) who had either received early or standard palliative care.

"Increasing numbers of patients receive multiple regimens of chemotherapy with ongoing administration near the end of life, although the likelihood of response to second-line-chemotherapy for malignancies such as [NSCLC], is less than 10%," write study authors Joseph Greer et al from Massachusetts General Hospital Cancer Center in Boston, USA.

It is thought that timely referral to a hospice results in better quality of death and better mental and physical health outcomes for family members, according to the researchers, who hypothesized that ambulatory palliative care soon after diagnosis would encourage timely referral and termination of chemotherapy in the final months.

The study involved 151 patients (mean age 65 years) newly diagnosed with metastatic NSCLC; 74 were assigned standard care and 77 received early palliative care integrated with standard care. The study follow-up period was 18 months, by which time 88.1% of the cohort had died.

Patients receiving this early care attended a consultation with a member of the palliative team within 3 weeks of enrollment and once a month thereafter, with the option of scheduling additional sessions as required. Standard care group patients only received palliative care on their request.

The researchers found that the early palliative group had a lower rate of chemotherapy use within 60 days of death than individuals receiving standard care: 52.5% of early palliative patients compared with 70.1% of standard care patients. There was no difference in the overall number of received chemotherapy regimens between the two groups.

Early palliative care significantly reduced the use of intravenous chemotherapy within 60 days of death compared with the standard care group, but no such difference was found for the patients who received oral chemotherapy.

Rates of hospice referral did not differ between the two study groups, but the early palliative care patients did enroll in a hospice longer before death than the standard care group. Significantly more of the early palliative care patients were enrolled in hospice care for more than 1 week compared with the standard care patients (60.0 vs 33.3%).

"The results of the present study add to the growing body of evidence supporting the utility of early palliative care integrated with standard oncology care in the outpatient setting for patients with metastatic NSCLC," conclude the researchers.

By Chloe McIvor

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