Early Palliative Care May Improve Quality of Life in Advanced Cancer

Early Palliative Care May Improve Quality of Life in Advanced Cancer40

Early palliative care improved scores in overall health status or quality of life (QOL) at 18 weeks in patients with advanced cancer, according to findings published in JAMA Network Open.

In addition, researchers noted no significant improvements in QOL at 12 weeks and 24 weeks. The findings also demonstrated that more sessions related to early palliative care were linked with an increased 2-year survival rate.

“Findings from this study suggest the need to develop guidelines for systematic [early palliative care] to improve its quality, and to develop various methods of providing [early palliative care] to increase patients’ adherence with interventions,” the study authors wrote.

Patients assigned early palliative care, especially at 18 weeks, showed strong improvements in scores indicating overall health status or QOL (11.00 points; 95% CI, 0.78-21.22; P = .04; effect size = 0.42). At 12 and 24 weeks, patients did not experience significant differences in these scores.

Over 24 weeks, patients in the intervention group exhibited a significant improvement in self-management or coping skills compared with the control group (20.51 points; 95% CI, 12.41-28.61; P < .001; effect size = 0.93).

The intervention group had a higher overall survival rate compared with the control group; however; the difference between both groups was not significant. Patients receiving 10 or more early palliative care interventions, including care team meetings and telephone coaching sessions, demonstrated an increased probability of 2-year survival (53.6%; P < .001).

“[This is] indicating that increasing adherence is an important factor in these interventions,” the study authors wrote.

At 18 weeks, there were significant differences in the factors used to measure QOL including appetite loss (−14.51 points; 95% CI, −27.57 to −1.45; P = .03; effect size = −0.42) and constipation (−11.53 points; 95% CI, −23.37 to −0.30; P = .04; effect size = −0.41). At 24 weeks, factors including 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) showed significant score changes as well.

Within the first 3 weeks, patients enrolled in this study met with the integrated palliative care team to create a plan incorporating early palliative care and advanced care planning. After approval, palliative care specialists conducted telephone coaching sessions once a week for the first 12 weeks and then biweekly until the end of the study. Symptom control and other mental, social, and spiritual problems were evaluated once every 3 weeks for 6 months for advanced care planning. Every 3 weeks, palliative nurses assessed symptoms using the 12-item symptom scale of the MD Anderson Symptom Inventory and Patient Health Questionnaire-2.

The study included 144 adults with a mean age of 60.7 years. Patients assigned to the control group (n = 71) received usual oncological care, while those assigned to the intervention group received early palliative care (n = 73). Of the enrolled patients, 83 were male (57.6%) and 61 were females (42.4%), with nearly half of patients having an education 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.

Integrated palliative care teams included palliative care clinicians, professionally trained health coach nurses, and social workers, depending on the hospital. Nurses with over 3 years of experience were considered health coaches, while nurses who have administered palliative care and received specialized training were considered specialist palliative care clinicians. This training included 14 hours of coaching practice through tele-classes and 23 hours of offline lectures.

Primary outcomes of the study included change in overall QOL from baseline to 24 weeks after enrollment. Self-evaluations were conducted at 12 and 18 weeks. Secondary outcomes included social and existential burdens, crisis-overcoming capacity, 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 Open. 2024;7(8):e2426304. Published 2024 Aug 1. doi:10.1001/jamanetworkopen.2024.26304