Nurse input benefits terminal cancer patients
MedWire News: Contact with an oncology advanced registered nurse practitioner (ARNP) can significantly enhance quality of life for patients with metastatic cancer, a pilot study suggests.
The researchers say the ARNP-directed intervention is a promising model for incorporating palliative care and should be "extremely helpful to oncologists" in both community and academic medical practices.
The intervention was designed to address concerns that patients with advanced cancer, who are still receiving disease-specific management, may have unmet psychologic and social needs. Additionally, cancer treatment itself can cause significant morbidity, including depression, fatigue, and anxiety.
"The inattention to the spiritual, social, rehabilitative, and psychological needs of the patients and their families are missed opportunities for interventions that may bring significant palliative benefits," write Gerardo Colon-Otero (Mayo Clinic, Jacksonville, Florida, USA) and team in the Journal of Palliative Medicine.
The new intervention comprised two consultations with an oncology ARNP, 1 month apart. During the consultations, the ARNP reviewed the benefits of hospice care, discussed living wills and advanced directives (the "Five Wishes" document), and assessed patients' psychologic, physical, intellectual/cognitive, social, and spiritual needs.
A total of 26 patients were enrolled in the study and randomized to receive the ARNP intervention or usual care. The intended total was 100 patients but the study was stopped early because of newly published data demonstrating the benefits of nurse intervention in terminal cancer patients.
Between baseline and follow up, patients' emotional quality of life (as indicated by subscores on the Functional Assessment of Cancer Therapy-General [FACT-G] questionnaire) rose in the ARNP-intervention group and declined in the usual care group, leading to a significant difference.
Also, patients' overall mental quality of life (as indicated by subscores on the Linear Analog Self Assessment scale [LASA]) rose in the ARNP-intervention group and declined in the usual care group, again leading to a significant between-group difference.
Other FACT-G and LASA subscores, as well as total scores, did not differ between the groups, however, and scores on a "hospital knowledge questionnaire" were unaltered following the intervention.
The researchers say that the small sample size together with shorter-than-planned follow up are important limitations to their study. Nevertheless they say the results are "encouraging" and conclude: "Our pilot study demonstrated that a simple ARNP-directed intervention focusing on early palliative care, hospice education and quality of life assessments, improves the emotional well being and mental quality of life of patients with metastatic cancer".
They add: "The success of this study brings a simple way to introduce advanced directives discussions and symptom assessment early in the clinical course of metastatic cancer patient care by a professional (in this case the ARNP) who is part of the oncology team."
By Joanna Lyford