Evidence in Support
Clinical studies demonstrate that palliative care improves quality of life scores, and some studies found that it lowers rates of aggressive end-of-life treatments and may modestly improve survival.3 Though most studies show at least an improvement in quality of life, variability in outcomes is likely a result of differences in the palliative care interventions.5 All current research report that palliative care also reduces costs.3
A phase 3 trial of early palliative care among patients with newly diagnosed non-small cell lung cancer (NSCLC) found that it increased quality of life and prolonged survival by 2.7 months, furthermore it was shown to decrease aggressive end-of-life care and depression compared with the standard of care.6 The ENABLE II study of patients with advanced cancer found that palliative care with an advanced practice nurse improved quality of life and depressed mood compared with usual care.7 In a cluster randomized trial of patients with stage III or IV solid tumors with a prognosis of 24 months or less demonstrated that early palliative care improved quality of life and symptoms intensity at 4 months compared with standard care.8
Other studies have found similar outcomes for quality of life improvement, though one study of patients with NSCLC found no significant difference between intensive palliative care intervention and standard care for hospice use, end-of-life chemotherapy, and survival.9
Models of Care
The ASCO and NCCN guidelines recommend that palliative care be provided through interdisciplinary teams in both the outpatient and inpatient settings.3,4 For some caregivers, particularly those who live in rural areas, palliative services may be best provided by telephone.3 In addition to a palliative care physician or advanced practice provider, the palliative team might include palliative care nurses, social workers, chaplain, rehabilitation specialists, among others, depending on the needs of the patient and caregiver, as well as the resources available to the oncology practice.
In community practices, limited palliative resources are the norm and palliative services are frequently provided by the ambulatory oncology practices.10 Although formal palliative services are optimal, this may not be feasible in the community setting. There is also a lack of palliative care specialists; thus, oncologists and other oncology providers should provide palliative services.