Early palliative care interventions did not lead to meaningful improvements in quality of life (QOL) or survival in patients with head and neck cancer enrolled in a prospective study in India.1
The study included 180 patients with squamous cell carcinoma of the head and neck region who were set to receive palliative systemic therapy. They were randomly assigned to receive standard systemic therapy with or without comprehensive early palliative care.
QOL scores and symptom burden assessments at 3 months showed no differences in outcomes between the study arms. The median overall survival was similar between the arms as well.
These results suggest “there was a limited impact of early palliative care in head and neck cancer in this study,” wrote Vijay Maruti Patil, MBBS, MD, DM, of Homi Bhabha National Institute in India, and co-investigators.
However, the results require mindful interpretation, according to Jessica Bauman, MD, chief of the division of head and neck medical oncology at Fox Chase Cancer Center in Philadelphia, Pennsylvania, who co-authored an editorial that accompanied the study. 2
The study should not lead people to believe that early palliative care doesn’t work in head and neck cancers, Dr Bauman and her co-author wrote. Instead, the results suggest “a one-size-fits-all approach for palliative care interventions” is not appropriate for this patient population.
Early Palliative Care May Improve QOL
Several studies have shown improvements in QOL with early palliative care interventions, according to Pallavi Kumar, MD, director of oncology palliative care at Penn Medicine and an assistant professor of clinical medicine in the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
In the ENABLE II study (ClinicalTrials.gov Identifier: NCT00253383), a nurse-led, palliative-care–focused intervention in patients with advanced cancers led to improvements in QOL and mood.3 However, as Dr Kumar noted, this improvement occurred in the months before death and not at 12 weeks, which was the primary endpoint.
In a seminal study published by Jennifer Temel et al, early integrated palliative care also improved QOL and mood among patients with advanced lung cancer at 12 weeks.4
However, much of the available data “point to 12 weeks being too early in the course of disease and that perhaps longer follow-up is required to accurately assess the impact of early palliative care,” Dr Kumar said.
Dr Bauman pointed out that neither of these studies included patients with head and neck cancers.