Integrating Palliative Care into Standard Oncology Care
Early Palliative Care Intervention Improves Satisfaction with Care, Prevents Decline in QOL in Patie
Palliative care, concurrent with standard oncological care, should be considered early in the course of illness for any patient with metastatic cancer or high symptom burden.1 Palliative care can be described as specialized medical care for patients with serious illnesses, and it focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness, regardless of the diagnosis. Both the patient and the patient's caregivers benefit when treatment addresses the whole patient, and not just the disease. Palliative care focuses on the physical and psychological consequences of treatment, and as such, the significant suffering of patients and their families can be effectively addressed by modern palliative-care teams.2
The American Society of Clinical Oncology (ASCO) recently published a provisional clinical opinion addressing the integration of palliative care into standard oncology care.1 This opinion states that patients with metastatic non-small cell lung cancer should, at initial diagnosis, be offered concurrent palliative care and standard oncologic care. Additionally, ASCO recommends this combination of care early in the course of illness for any patient with metastatic cancer or with high symptom burden.
To implement palliative care, clinicians are encouraged to do the following with their patients: routinely ask their patients about their quality of life; explain palliative care; consider a referral for early palliative care; routinely discuss their patient's future and prognosis; encourage patients to prepare for sudden problems; establish a durable medical power of attorney; and help patients and their families prepare for end-of-life care.3
Benefits from Palliative Care
Conversations about palliative care have increased since Temmel and colleagues published results of their findings in the 2010 New England Journal of Medicine articles about a randomized trial of patients with metastatic non-small cell lung cancer.4 These newly diagnosed patients were assigned to either early palliative care integrated with standard oncologic care, or standard oncologic care alone. Notably, those receiving early palliative care had significant improvements in their quality of life and in their mood. Also, the patients receiving palliative care had less aggressive end-of-life care, yet had an average of 2.7 months of longer survival.
Early involvement of palliative care has not demonstrated excessive costs or harm to patients or caregivers in any trial to date.1 Additionally, studies have shown improved outcomes at costs that were lower than that of standard oncologic care only.1,5,6 A randomized, controlled trial of advanced-cancer patients focused on the outcomes from nurse-led palliative intervention using a case-management educational approach, and found that the patients had higher scores for quality of life and mood. However, the trial did not find any improvements in symptom intensity, reduced days in the hospital or intensive care unit, or decreased visits to the emergency department.7
A recent study on integrating palliative care into the outpatient, private-practice setting found that this reduced patients' symptom burden, and provided a service that overwhelmingly satisfied the oncologists.8 Each time the palliative-care team was consulted, the oncologists saved an average of 170 minutes per palliative-care referral. Over time, this leads to an impressive amount of time saved and increased potential to see new patients, which could potentially increase revenue for the practice. Additionally, this integration provides quality care to patients who received assistance in managing their symptoms, while allowing oncologists to spend time evaluating new patients, determining study protocol regimens, and administering chemotherapeutic agents.
When oncologists are engaged in providing palliative care to their patients, this helps to address the scarcity of information and understanding that patients and their families experience, and also leads to improved patient trust.3