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Early palliative care intervention improved caregivers’ quality of life
CHICAGO — Early implementation of a phone-based palliative care support program improved quality of life for caregivers of patients with advanced cancer, according to results of a randomized trial presented at the ASCO Annual Meeting.
“This is the first palliative care study to include family caregivers, and it investigates the important issue of timing,” Marie Bakitas, DNSc, Marie L. O'Koren endowed chair and professor at the University of Alabama School of Nursing, said during a press conference. “Our results demonstrate that family caregivers’ quality of life, mood and stress burden improved [among those who] received the intervention closer to the time of diagnosis.”
The ENABLE III study included 207 patients with recurrent or metastatic cancer and 122 family caregivers, all of whom received palliative care support via a phone-based intervention.
Researchers randomly assigned patients and caregivers to one of two groups. One group received the intervention within 2 weeks of randomization, and the other group received the intervention 12 weeks after randomization.
Advanced practice palliative care nurses used a phone-based curriculum called Charting Your Course and provided monthly supportive care follow-up to patients and caregivers.
The curriculum taught participants how to manage problems using planning, creativity, optimism and expert information. It included information about aspects of self-care, such as healthy eating, relaxation and exercise. It addressed how to effectively partner with care recipients to manage symptoms and build a support network. The program also covered decision-making, decision support and advance care planning.
Researchers assessed quality of life and depression — as well as subjective burden, objective burden and demand burden — at baseline, 6 weeks, 12 weeks, 18 weeks and 24 weeks. After that, assessments continued every 12 weeks until patient death or study completion.
The current analysis includes the assessment of benefits for caregivers only.
Results showed caregivers who received the immediate intervention demonstrated improved overall quality of life, lower rates of depression and less demand burden than those assigned the delayed intervention.
The mean estimated treatment effects — calculated as immediate minus delayed — from the initiation of the intervention to 12 weeks were -7.2 (SE, 3.4) for quality of life (P=.02), -6.9 (SE, 2) for depression (P=.006), and -1 (SE, 0.6) for subjective burden (P=.1).
The mean estimated treatment effects measured backward from the time of patient death were -4.9 (SE, 2.6) for quality of life (P=.07), -3.8 (SE, 1.5) for depression (P=.02), -1.1 (SE, 0.4) for subjective burden (P=.01).
The findings support early initiation of concurrent oncology palliative care to maximize benefit for caregivers, the researchers concluded.
“Family caregivers are a crucial part of the patient care team. Because the well-being of one affects the well-being of the other in a reciprocal way, both parties benefit when caregivers receive palliative care,” Bakitas said. “Unfortunately, the full range of palliative care services are rarely taken advantage of because palliative care is often introduced too late in the course of cancer treatment. Patients and caregivers should understand that palliative care is not end-of-life care but rather an extra layer of support that can be offered along with curative medical treatments.”
For more information:
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Bakitas M. Abstract #LBA9513. Presented at: ASCO Annual Meeting; May 30-June 3, 2014; Chicago.
Disclosure: The research was supported by the NIH.
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Improving the mental health and well-being of the caregiver is an essential component of good palliative care. This high-level study shows that we should, in fact, include palliative care from the time of diagnosis. There was also a 1-year survival difference between patients who received the early intervention vs. the delayed intervention. This intervention not only enhances the quality of life with the caregivers, but it also enhances quality of care for patients. Palliative care needs to be incorporated into the care of all of our patients with cancer from the time of diagnosis.