Palliative Care Services by Income and Caregivers’ Needs

Interviewed experts agreed that this study was an important first step in addressing a research gap regarding integration of palliative care services in low- and middle-income countries (LMIC).

“One of the aspects we know about early palliative care studies in the United States is that they have been associated with decreased aggressiveness of care at the end of life, longer stays on hospice, and lower receipt of chemotherapy near the end of life,” Dr Bauman said. “It was uncommon to see aggressive care at the end of life on either arm of this study, raising the fundamental question of what the specific goals of integrating early palliative care in LMIC should be.”

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She noted that all patients in both arms of the study were fully educated at diagnosis about their disease, prognosis, treatment options, and cost of treatment such that they understood the implications and expected illness trajectory, a practice not often seen in the United States. Further, study participants reported having adequate family support, with a median of 3 to 4 caregivers.

“The authors of the study note that patients in India often have multiple caregivers due to the culture of joint family structure and, therefore, more access to emotional, social, and financial support — all of which can increase a patient’s perceived quality of life,” Dr Neuendorf said.

Dr Bauman noted that the study did not assess caregiver outcomes.

“Caregivers need to be addressed in palliative care for head and neck cancer,” she said. “If patients have a need for feeding tubes or special meals, if they need wound care or pain control, that all requires special attention.”

Dr Bauman also pointed out that caregiver outcomes are important to assess the impact of palliative care interventions.

Advocacy for Expanded Palliative Care

Dr Bauman concluded that this study should raise the question of whether patients with head and neck cancer require palliative care interventions earlier in their disease course. She and her colleagues are working on a study to test the feasibility of integrating this care into curative treatment for head and neck cancer and whether that approach will ultimately lead to improved outcomes.

According to Dr Neuendorf, many palliative care advocates hope the principles of primary palliative care become standard practice for any health care provider caring for patients with serious illness, especially because there is a shortage of palliative care providers.

“All patients with cancer should be aware of their diagnosis, prognosis, and the intent of chemotherapy, not just patients who are being seen by palliative care specialists,” Dr Neuendorf said. “When primary palliative care principles are infused into health care settings, patients with serious illness can have an increase in quality of life and a decrease in symptom burden. Palliative care specialists can then be utilized when patients have needs beyond primary palliative care; needs such as complex symptom management or communication needs.”


  1. Patil VM, Singhai P, Nornha V, et al. Effect of early palliative care on quality of life of advanced head and neck cancer patients: a phase III trial. J Natl Cancer Inst. Published online February 19, 2021. doi:10.1093/jnci/djab020
  2. Bauman J, El-Jawahri A. One size does not fit all: the need for population-specific palliative care interventions. J Natl Cancer Inst. Published online February 16, 2021. doi:10.1093/jnci/djab021
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