Early palliative care improves quality of life in patients with metastatic lung cancer

Introducing palliative care soon after diagnosis of metastatic non-small-cell lung cancer improves quality of life, mood and possibly survival, while decreasing aggressive end-of-life care, according to a new study.

Researchers at Massachusetts General Hospital performed an unblinded randomized, controlled trial that assigned patients with a new diagnosis of non-small-cell lung cancer to receive standard care or early palliative care plus standard care. Those assigned to early palliative care met with a clinician from the palliative care team within three weeks of study enrollment and a minimum of once a month thereafter; patients could schedule additional visits at their own or their clinicians' discretion. The palliative care visits were used to assess physical and psychosocial symptoms, outline care goals, help patients make decisions about treatment and coordinate care. Patients who were assigned to standard care didn't meet with the palliative care team unless they, their family or their oncologist requested a visit.

The study measured quality of life at baseline and at 12 weeks with the Functional Assessment of Cancer Therapy–Lung (FACT-L) scale, which ranges from 0 to 136. Patients' mood was measured at baseline and at 12 weeks using the Hospital Anxiety and Depression Scale. The authors also looked at the type and amount of end-of-life care that patients received, according to electronic medical records. The study results appear in the Aug. 19 New England Journal of Medicine.

Seventy-four patients were assigned to the standard care group, and 77 were assigned to receive early palliative care. One hundred seven patients (86%) survived to 12 weeks and completed the study assessments. Patients in the early palliative care group had better quality of life at 12 weeks than those receiving standard care (mean FACT-L score, 98.0 vs. 91.5; P=0.03) and were also less likely to report depressive symptoms (16% vs. 38%; P=0.05). Patients receiving palliative care were less likely to receive aggressive end-of-life care (33% vs. 54%; P=0.05) but had longer median survival after diagnosis (11.6 months vs. 8.9 months; P=0.02).

The authors pointed out that their study involved highly trained clinicians at a single facility, as well as only one disease, limiting its generalizability. Among other limitations, the patients were not ethnically diverse and all parties were aware of the study group assignments. However, the authors concluded that early palliative care can improve quality of life and perhaps survival in patients recently diagnosed with metastatic non-small-cell lung cancer, and that it may also lead to more appropriate end-of-life care.

An accompanying editorial noted that the study challenged conventional ideas about palliative care, which is often considered an alternative to standard care rather than an adjunct. The editorialists said that the findings on improved survival need to be replicated and pointed out that improved quality of life in the early palliative care group might be due simply to increased time and attention from clinicians rather than to any specific interventions. However, they called the study "an important step in confirming the beneficial outcomes of a simultaneous care model that provides both palliative care and disease-specific therapies beginning at the time of diagnosis." Palliative care should be made "an essential and routine component of evidence-based, high-quality care for the management of serious illness," they concluded.