Integrating Palliative Care Early On Improves Outcomes for Family Caregivers

Areej El-Jawahri, MD

Early palliative care integrated with oncology care benefits not only patients with cancer but also family caregivers. These phase III data were presented in a presscast held in advance of the 2016 ASCO Annual Meeting.

At a 12-week analysis, primary caregivers — a category that could include family members or friends — reported fewer depression symptoms and improved vitality and social functioning compared to caregivers of patients receiving strictly medical care. After 24 weeks, the lower rate of depression symptoms was persistent, but there was no difference observed in vitality and social functioning.

“We can now say that the benefits of early palliative care can extend beyond patient outcomes and can actually positively impact family caregivers,” said Areej El-Jawahri, MD, during the presscast.

This is the first study to show such an impact, added El-Jawahri, an oncologist from Massachusetts General Hospital Cancer Center.

In total, 350 patients with newly diagnosed incurable lung or gastrointestinal cancers and 275 family caregivers were enrolled and randomized to receive usual oncology care (n = 138) or usual care in addition to palliative care (n = 137).

In the palliative care visits, clinicians focused most on symptom management, coping, establishing rapport, and “illness understanding.” The most common symptoms addressed were pain and fatigue, while the most common coping topics addressed were redirecting hope, coping counseling, and behavioral coping.

Family caregivers were not required to attend palliative care sessions, El-Jawahri said, though over 50% of them did.

Family caregivers’ quality of life and mood were measured using the Medical Outcomes Study Health Survey Short Form-36 (SF-36) and Hospital Anxiety and Depression Scale (HADS), respectively. Analyses were taken at baseline, at 12 weeks, and at 24 weeks.

At the 12-week assessment, family caregivers of patients in the intervention group reported higher vitality (1.1 vs -3.2, P = 0.05) and social functioning (-3.0 vs -3.8, P = 0.02), and fewer depression symptoms (-0.45 vs 0.24, P = 0.03) compared with their counterparts in the group receiving usual care alone.

During this assessment, “there were also non-significant improvements in other quality-of-life domains, such as bodily pain and physical-role functioning,” El-Jawahri said.

At the 24-week assessment, family caregivers in the early palliative care group still had a lower rate of depression symptoms (-0.37 vs 0.28, P = 0.05), but there were no differences in vitality or social functioning compared with the other group.

Overall, patients randomized to the intervention experienced an improvement in quality of life and depression; these results will be presented in a separate study at ASCO.

El-Jawahri pointed out that improvement in family caregiver outcomes seemed to be “at least partially mediated” by improvement in patients’ quality of life.

The importance of palliative care — both early and otherwise — has been well studied.

“We do know that the integration of palliative care can improve quality of life and mood in patients with advanced cancer,” El-Jawahri said, emphasizing that early palliative care can even have a positive impact on outcomes for patients.

Palliative care, which El-Jawahri defined as care given by a multidisciplinary team of doctors, nurses, social workers, and psychologists, can provide an “extra layer of support” for patients.

Julie M. Vose, MD, MBA, FASCO, ASCO president, echoed this sentiment and reinforced the importance of this study’s findings.

“This study really points out that we have so many ways to help our patients and their families through their treatment,” said Vose, who moderated the presscast.

“Early palliative care is not only going to help the patient, but also help the family and the caregivers to get the patient through treatment with an improvement in their quality of life.”

El-Jawahri A, Jackson VA, Greer JA, et al. Early integrated palliative care improves family caregivers (FC) outcomes for patients with gastrointestinal and lung cancer. J Clin Oncol. 2016 (suppl; abstr 10131).