Early palliative care is prolonging life for people with advanced lung cancer, even though those same patients had less aggressive end-of-life treatment, according to a study published in The New England Journal of Medicine.
The study validates that palliative care is most effective when started soon after the patient’s diagnosis, says Theresa Gillis, M.D., medical director, Oncology Rehabilitation and Pain Management Services at the Helen F. Graham Cancer Center.
“This large and well-designed study is a potential game changer,” she says. “Hopefully, it will help more people to understand that palliative medicine is about serious illness care, not end-of-life care.”
In the study, “Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer,” patients who received standard oncologic care had a median survival time of nine months, compared with nearly a year for patients who received standard care and started outpatient palliative care within three months of diagnosis. The patients who had palliative care also had less chemotherapy and less aggressive end-of-life care, less depression and a significantly better quality of life.
Earlier studies had suggested that palliative care is often introduced too late in treatment to have a meaningful effect for cancer patients.
Palliative care — derived from “palliare,” Latin for “to cloak” — traditionally focuses on alleviating the pain, symptoms and stress of a disease rather than treating the disease itself.
But high-quality palliative care has evolved to encompass the patient’s physical, emotional and social concerns, including such issues as transportation and finances. At the Helen F. Graham center, patients and their families receive support from a team that includes doctors, nurses, social workers and case managers, as well as referrals to community resources.
“In palliative care, we really help patients understand the progression of their illness and what their options are, and focus on ways to reach the best possible quality of life,” Dr. Gillis says. “It is hard for people who are very ill to have conversations about life-threatening illness with their families and a palliative care physician can help them to cross that bridge of fear and anxiety.”
Those conversations include making certain the patient’s electronic medical record includes end-of-life instructions and such decisions as whether or not to use a ventilator. Palliative care also helps patients to express personal wishes, such as holding a cherished pet or spending time with a loved one at home.
“Once you get down to what really matters most, there is a tremendous sense of peace for patients and their families,” Dr. Gillis says.