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Earlier palliative care helps in outpatient cancer treatment

Thursday February 20, 2014
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In a Canadian study described as the first to assess the impact of providing early outpatient palliative care versus standard oncology care in a wide range of advanced cancers, earlier care improved quality of life and patient satisfaction.

The four-year study involved 461 patients at 24 medical oncology clinics at Princess Margaret Cancer Centre, part of University Health Network in Toronto, with advanced lung, gastrointestinal, genitourinary, breast and gynecologic cancers.

The findings, published Feb. 19 on the website of The Lancet, demonstrate the benefits of early specialized palliative care provided by cancer centers in outpatient clinics, said Camilla Zimmermann, MD, the study’s principal investigator and head of UHN’s palliative care center.

To put the findings into practice, palliative care teams should be involved much earlier in the course of illness to provide collaborative care together with oncologists, said Zimmermann, who also is medical director at the Al Hertz Centre for Supportive and Palliative Care at the Princess Margaret Cancer Centre and an associate professor at the University of Toronto.

“The key outcome validates that quality of life improves with the core intervention of seeing a physician and nurse with specialist palliative care training once a month in the outpatient clinic,” Zimmermann said in a news release.

“Another important outcome is that patients reported improved satisfaction of care. We found that patients appreciated having a team of professionals available to provide additional support navigating the cancer system and coping with multiple medical and social issues.”

The study was a cluster randomized controlled trial involving patients with advanced cancer whose prognosis was greater than six months. It assessed impact using five standard clinical measurement tools to determine quality of life, symptom control, satisfaction with care and difficulty with medical interactions.

All participants completed a baseline survey and received the same clinical care over four months. The 228 patients in the early intervention group also received formal monthly consultation with the palliative care team in a specialized outpatient clinic, plus regular phone follow-up. Initial palliative consultation included a comprehensive, multidisciplinary assessment of symptoms, psychological distress, social support and home services. When the study ended, patients were offered continued follow-up in the outpatient palliative care clinics.

“Quality of life was an outcome of interest because it is a central focus of palliative care,” said Zimmermann. “The research team used a cancer-specific measure encompassing physical, function, social and psychological domains, as well as the spiritual domain, which is of particular relevance in patients with advanced cancer.”

Despite the worse status of the intervention group at baseline, the study showed a trend of improvement in quality of life at three months and clinically meaningful improvement at four months.

Similarly, patient satisfaction with care improved substantially at both three and four months in the early palliative care group, while it deteriorated in the control group.

Results in the other domains assessed — symptom management and medical interactions — showed differences favoring the early palliative care group only at four months.

Zimmermann, whose main research focus is effective delivery of palliative care, plans to assess the impact on family caregivers of providing early palliative support to advanced cancer patients, as well as the economic cost, or cost savings, of implementing this model of early palliative care.

Study abstract: www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2962416-2/abstract


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