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Early palliative care optimized timing of final IV chemotherapy, transition to hospice
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2011 ASCO Annual Meeting
CHICAGO — Patients with non-small cell lung cancer who had early palliative care integrated with standard oncology care received less aggressive care at end-of-life and spent more time in hospice without a reduction in survival, compared with patients who underwent standard care.
The introduction of early palliative care did not result in patients receiving fewer lines of chemotherapy, added Joseph A. Greer, PhD. Greer, associate director of behavioral medicine at Massachusetts General Hospital, presented the results of a single-site study at the 2011 ASCO Annual Meeting.
“The observed survival benefit that we noted in our palliative care trial last year does not appear to be due to participants receiving more lines of chemotherapy or having longer PFS on initial regimens,” he said. “Rather, early palliative care appears to optimize the timing of final chemotherapy administration and the transition to hospice services, which are key measures to quality end-of-life care.”
These results update previous findings at Massachusetts General that introducing palliative care soon after diagnosis for patients with metastatic NSCLC is associated with better quality of life, mood and survival. Researchers designed the current study to explore how early palliation effects treatment at the end-of-life.
From June 2006 to July 2009, researchers randomly assigned 77 patients to receive palliative care within 8 weeks of diagnosis and 74 patients to standard oncology care alone. Participants in the intervention group consulted with palliative care clinicians at least monthly until death.
At 18 months of follow-up, 88% of patients had died. Compared with the standard care group, patients assigned to early palliative care had a lower rate of IV chemotherapy utilization within 60 days of death (24.1% vs. 47.0%), a longer median interval between the last dose of IV chemotherapy and death (64.0 days vs. 40.5 days) and higher enrollment in hospice care for greater than 1 week before death (59.6% vs 33.8%). Patients in the early palliative care group spent an average of 24 days in hospice compared with 9.5 days for the standard care group.
Early palliative care did not affect oral chemotherapy use. Greer added that there was no difference between the groups in time from first line to second line therapy or from second line to third line.
“It’s important to note that this reduction in IV chemotherapy utilization in the early palliative care group served no detriment to survival,” he said. “In addition, an important and salient outcome of reducing IV chemotherapy for the early palliative care group was that they were able to access hospice services sooner than those in the standard care group, and for durations greater than one week.” – by Jason Harris
For more information:
- Greer JA. #6009. Presented at: 2011 ASCO Annual Meeting; June 3-7; Chicago.
Disclosure: Dr. Greer reported no relevant financial disclosures.
End of life care is receiving increasing attention, so we’re getting more emphasis on helping patients have a good quality of death. Yet we continue to see aggressive care on patients with advanced disease, including by the same research team as outlined here. We know that aggressive care represents a barrier to early referrals to hospice, so it’s critically important to identify predictors of this aggressive care so we can target end-of-life decision-making interventions.
- Susan Yount, PhD
Research Assistant
Professor in the Department of Medical Social Sciences,
Northwestern
University Feinberg School of Medicine
Disclosure: Dr. Yount reported no relevant disclosures.
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