Palliative care given to patients soon after they receive a diagnosis of advanced cancer has statistically significant effects on their survival, according to research published in the Journal of Clinical Oncology.
Studies reporting on 207 advanced cancer patients and 122 of their caregivers who participated in a trial called ENABLE III revealed benefits to patients who received care soon after diagnosis versus 12 weeks later.
“Palliative care is about providing an extra layer of support so that patients can live well and families can be supported,” principal investigator Marie Bakitas, DNSc, professor, and Marie L. O’Koren Endowed Chair, University of Alabama at Birmingham School of Nursing, said. “These data support the importance of providing this care at the same time as medical treatments aimed at fully curing disease. Too often, that is not the case.”
The cancer patients and their families were from a National Cancer Institute cancer center, a Veterans Affairs Medical Center, and community outreach clinics, and were randomly assigned to receive consultation and nurse coaching sessions once per week for six weeks. Each patient received follow-up thereafter. The study showed a 63% one-year survival rate for patients who received early palliative care compared to 48% among patients whose care was delayed, according to the articles.
Investigators said family caregivers who receive support and education have a greater ability to provide support for their patients, and providing patients with palliative care eases the family’s burden.
Researchers studied the caregivers of patients with advanced cancer between October 2010 and March 2013. Each caregiver received three weekly telephone coaching sessions, monthly follow-up and a bereavement call either early after enrollment in the study or three months later. Outcomes studied were quality of life, depression and burden (objective, stress and demand). The average age of the subjects was 60 and most were female.
Although quality of life was not statistically significant, the study reveals that the early group caregivers had lower depression scores at three months and lower depression and stress burden in the terminal decline analysis.
“Palliative care for caregivers should be initiated as early as possible to maximize benefits,” Nick Dionne-Odom, PhD, postdoctoral fellow in the SON and lead author of the family caregiver ENABLE Trial outcomes, said. “If patients and clinicians wait to introduce palliative care when a person is actively dying, it limits the full range of services that patients and their families can receive. Anyone who has been through cancer with a family member can attest to the physical, psychological and existential burden it places on both parties.”
Getting an extra layer of support early and concurrently with curative medical treatments is vital to helping patients and caregivers to develop coping skills needed for the cancer journey, Dionne-Odom said in the study.
Bakitas pointed out that reimbursement mechanisms regardless of prognosis, and increased clinician education also are needed to train specialists and general practitioners in palliative care.
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