Patients with metastatic non–small-cell lung cancer (NSCLC) who received early palliative care as well as standard care had a better quality of life (QoL), improved mood, and, despite receiving less aggressive end-of-life care, lived longer than patients who received standard care alone, a new study shows.
“Although our findings must be replicated in a variety of care settings and cancer populations, the results nonetheless offer great promise for alleviating distress in patients with metastatic disease and addressing critical concerns regarding the use of health care services at the end of life,” the authors write in the August 19 issue of the New England Journal of Medicine.
Jennifer S. Temel, MD, of Massachusetts General Hospital, Boston, and her colleagues randomized 151 patients with newly diagnosed metastatic NSCLC to either early palliative care combined with standard oncologic care or standard care alone. General guidelines for palliative care adapted from the National Consensus Project for Quality Palliative Care were included in the study protocol. The investigators used the Functional Assessment of Cancer Therapy-Lung scale and the Hospital Anxiety and Depression Scale to measure QoL and mood at baseline and at 12 weeks.
QoL at 12 weeks, the primary end point, was significantly better in patients receiving early palliative care than in those on standard care alone. In addition, significantly fewer patients in the palliative care group had depressive symptoms than did those in the standard care group (16% vs 38%). Fewer patients in the palliative care group received aggressive end-of-life care, but their median survival was significantly longer compared with the standard care group (11.6 months vs 8.9 months).
According to the authors of an accompanying editorial, “the results of this study show that palliative care is appropriate and potentially beneficial when it is introduced at the time of diagnosis of a serious or life-limiting illness—at the same time as all other appropriate and beneficial medical therapies are initiated.” They say that it is now possible to make palliative care “an essential and routine component of evidence-based, high-quality care for the management of serious illness,” and they note that “perhaps unsurprisingly, reducing patients’ misery may help them live longer.”